Cornerstone Behavioral Health
PIMSY and Cornerstone Behavioral Health: Enhancing Efficiency for a Promising Future in Integrated Behavioral Healthcare
Case Study Stats
Name: Cornerstone Behavioral Health (CBH)
Web Site: www.cornerstonebhc.com
Location: HQ in Bangor, ME / 2 locations
Customer: 9 years
Services: Outpatient and group therapy, behavioral health home/case management, psychological testing, medication management, substance use evaluations and treatment, medications for opioid use disorder (MOUD), and opioid health home (OHH) services.
Cornerstone Behavioral Healthcare (CBH) dedicates itself to client-focused excellence in integrated behavioral healthcare. It is committed to providing high-quality community services throughout Maine ethically, reliably, and effectively. This commitment includes advocating for positive change through community-based services in collaboration with private and State agencies.
CBH offers a comprehensive range of clinical services at various locations throughout Maine, delivered by a network of contracted professionals who specialize in providing high-quality care. These licensed providers employ a client-centered approach that prioritizes holistic care to address mental health and substance use challenges. This includes participation in the MOUD program, which utilizes medications combined with therapy to treat opioid addiction effectively. Additionally, the Opioid Home Health (OHH) service provides integrated care, including counseling, care coordination, medication support, peer recovery, and more, for individuals dealing with opioid dependency and other chronic conditions.
The healthcare industry is no exception to the demand for streamlined operations, especially when managing complex billing, documentation, and compliance requirements for numerous subcontracted providers throughout Maine. Cornerstone Behavioral Health sought a software partner with a robust system to help them manage their large-scale mental health operation.
In 2014, CBH partnered with PIMSY as a software solution provider, drawn to its extensive range of features and its capacity to enhance workflows while offering robust support for its vast healthcare network. This network includes many contracted professionals delivering high-quality care for mental health and substance use challenges across many locations throughout Maine, focusing on enhancing billing processes. To adequately support billing functionality for this vast network of contractors, CBH faced significant challenges in coordinating and maintaining seamless communication, requiring continuous manual efforts to ensure efficient, accurate, and compliant operations.
- Comprehensive Features: robust solution for billing, electronic health records, reporting, and practice management to streamline workflow.
- Compliance: HIPAA-compliant and meets Maine’s state-specific mental health regulations.
- Interoperability: easily integrates with other systems, enabling seamless data exchange across multiple practices in various locations.
- User-Friendly Interface: a user-friendly platform with minimal learning curves.
- Customer Support: the customer support team provides ongoing assistance even after implementation.
Before transitioning to PIMSY as a mental health EHR system, Cornerstone Behavioral Healthcare faced a trifecta of challenges in its multi-location network:
- Cumbersome Billing Processes: struggled with managing numerous billing processes, including private insurance, self-pay patients, MOUD, and OHH, leading to inefficiencies and revenue losses.
- Complex Compliance: clinicians utilized outdated record-keeping systems that hindered efficient patient care and compliance with Maine’s state and federal regulations.
- Communication Gaps: The multi-site operation encountered communication and data sharing difficulties across multiple locations, leading to fragmented care and lost information.
Streamlined Billing and Processes
PIMSY significantly enhanced overall operational efficiency through automation by eliminating unnecessary steps, reducing bottlenecks, and optimizing the billing process. For example, by utilizing the 835-posting procedure, we reduced manual paperwork, enhanced billing accuracy, and promoted efficient communication with insurance companies. The results were faster reimbursement, reduced errors, and improved financial management for healthcare providers, which resulted in cost savings and improved profitability.
Interoperability- Maine HIE (Health Information Exchange)
PIMSY and Cornerstone successfully integrated with Maine statewide HIE, facilitating effortless patient information exchange between providers. The integration is automated and runs in the background while agency staff performs typical day-to-day operations.
This has offered several benefits for Cornerstone, including these key advantages:
- Improved Care Coordination – allows a comprehensive view of client health data to enhance care coordination and make well-informed patient care decisions.
- Enhanced Client Safety – reduces medical errors, and providers can make safer and more effective clinical decisions.
- Faster Access to Critical Information – immediate access to patient data through the HIE ensures that healthcare providers can quickly retrieve crucial information.
- Reduced Redundancy – reduces the duplication of tests and procedures, saving time and resources.
- Enhanced Interoperability – connects different healthcare systems, EHRs, and providers while enabling seamless data exchange across various healthcare facilities.
- Data Accuracy – ensures that patient data is accurate and up to date to provide high-quality care.
- Improved Efficiency – easy access to health information reduces administrative burdens and frees more time for direct patient care.
- Cost Savings – reduces redundant tests, enhancing efficiency, and improving patient outcomes.
- Compliance with Regulatory Requirements – satisfies regulatory requirements and promotes incentives (i.e., MACRA, MIPS).
Denial Rate Decrease
PIMSY software solution reduced Cornerstone’s denial rate by 50%. This is attributed to factors contributing to enhanced efficiency and improved financial health. Below are key reasons behind the notable reduction in denial rates:
- Accurate Documentation – providing detailed and standardized documentation makes it less likely for denied claims due to insufficient or incorrect information.
- Utilization Management – managing authorizations resulting in fewer denials.
- Eligibility Verification – insurance eligibility is verified in real-time, reducing the risk of providing non-covered services.
- Claim Validation – provides error validations before submission.
- Compliance Support – adheres to Maine’s state-specific and federal regulations.
- Integrated Billing – automatically generates claims and complies with Maine-specific requirements for MaineCare.
- Electronic Claim Submission – claims are submitted electronically, reducing the risk of manual errors.
- Efficient ERA Handling – electronically receive and process Electronic Remittance Advice (ERA) from insurance companies.
- Financial Reporting – allows providers to track and analyze financial data.
Increased Reporting Functionality
Through automation and advanced reporting features, PIMSY significantly helped save time and increase efficiency and accuracy while reducing the likelihood of errors associated with manual reporting.
- Comprehensive Data Integration – seamlessly integrates with various data sources.
- User-Friendly Interface – users can easily navigate reporting tools.
- Adherence to Compliance Standards – ensures reporting features adhere to compliance standards and regulations.
- Automated Report Generation: automating the process streamlines reporting, saving time and reducing errors.
- Scalability – reporting capabilities scale to meet needs.
Cornerstone Behavioral Healthcare’s unwavering dedication to excellence in integrated behavioral healthcare has experienced invaluable empowerment and advancement through its partnership since 2014 with PIMSY. The challenges CBH encountered before embracing PIMSY, encompassing cumbersome billing processes, complex compliance issues, and communication gaps across multiple locations, have all found effective solutions through the innovative features and capabilities of the PIMSY platform.
This case study highlights the profound impact that a well-designed and comprehensive healthcare software solution can wield within an organization’s operations, yielding benefits for the provider and the clients they serve. PIMSY is poised to continue bolstering this partnership in the future through ongoing innovations, dedicated support, and adaptability to evolving healthcare needs, ensuring sustained success for Cornerstone Behavioral Healthcare.
“PIMSY has taken our authorization tracking to a new level. Working with authorizations in bulk saves us a lot of time, and we can produce accurate reports for our providers for new authorizations that need to be requested.” Phoenicia K., Senior Medical Billing Team Lead
“Our weekly Medicaid check typically has 400–500 line-item payments. It used to take us 20 hours per week to post and reconcile. PIMSY has taken that down to about one hour.” Phoenicia K., Senior Medical Billing Team Lead
“PIMSY’s 835 went great. I cannot believe how fast it is. It replaced about 15 hours of manual posting.” Phoenicia K., Senior Medical Billing Team Lead