Encoda LLC, a Philadelphia, PA based healthcare technology company, today was awarded US Patent #8447627, which is the technical basis for its groundbreaking medical revenue cycle automation tool. Some of the benefits and features of the Encoda suite are:

  • Reduction of back office staff by an astounding 40% and improved collections by 5%-7%, with ROI of three months if fully implemented.
  • Management by exception. People are employed only to handle exceptions.
  • Bolts on to existing client billing systems, preserving client investment in existing billing system so that only back office processes change while all front office processes stay the same.
  • With a single logon, regardless of geographical location or operating system, Encoda connects in real time to multiple instances of the same PMS and even different PM Systems with rollup
  • enterprise level functions for all functions, allowing back office staff to see only one program, thereby removing the biggest operational hurdle to practice acquisitions—the need to convert the acquired practice to the acquirer’s PMS/EHR.
  • Connects provider system directly to payer systems without clearinghouses or EDI fees.
  • Full reads and writes with the client billing system (unlike clearinghouses), replacing the billing system’s claim, payment and exception management processes with Encoda integrated and automated processes (again, unlike clearinghouses). You fix an exception in Encoda and it fixes it back in the client billing system.
  • 100% automated and 100% accurate for all currently known payment situations, with client rewards for presenting situations that we have not automated that can be automated.
  • Total cradle to grave history of all events normally outside the view of the billing system between and including charge capture to payment posting and final resolution, automatically mined for information with Encoda full business intelligence suite that enables drill down analysis using Excel as a front end. The tool comes with predesigned pivots that can be used as is and client may design and save their own as well.
  • Dashboard—called The Watchdog—of emerging situations of interest such as lapsed user- defined time lag limits for eight benchmark stages of a claim through payment posting, status of exceptions, agent productivity, provider productivity, payer productivity.
  • Automated Rules Based Scrubber that allows the user to write client specific scrubs, and automatically updates itself with payer specific and CCI edit scrubs.
  • Can adjudicate codes differently based on payers and billing sequence (primary, secondary, tertiary).
  • Work Queues partition-able by most CBO workforce hierarchical concepts (payer, doctor, type of issue, lines of business, etc.).
  • Posts to client General Ledger system, enabling client-customized departmentalization reporting and providing payee detail for refund payments from the GL system.
  • Enables patient-meaningful patient statements (coming soon).

“We are incredibly excited to receive this official recognition for five years of toil. This is disruptive technology. It is sometimes viewed with alarm and skepticism by the personnel currently manning medical back offices. This is not a system that wraps around existing client processes—which have never worked efficiently and never will, no matter how fervently embraced and how well employed. All current billing systems we have seen are anachronistic vestiges of a bygone era when there was no fast, secure, and inexpensive wide area network (the Internet) and, equally as important, no standards. As a result clearing houses arose to compensate. A clearinghouse is not your system and it is not the payer system. It is an intermediary, designed to bi-directionally translate disparate languages and to aggregate traffic on an expensive wide area network. It necessarily creates a Tower of Babel in which there are three separate systems (payer, clearinghouse and provider) that have three different sets of processes and actually record events and states with three different degrees of granularity and meaning and necessarily involves double and triple manual handling of each state change. Current back office processes are brave but futile attempts at damage control.

Since 2004 there has been one mandated claims and response standard called X12, mostly ignored by PMS vendors who, because of governmental subsidies, are disproportionately focused on meaningful use. EHR never put a dime in a doctor’s pocket.

One of our early large clients reduced its CBO staff from 75 to 40 while it grew its doctor staff from 128 to 188 doctors (46%) and its revenues from $48 million to $90 million (88%). Another more recent client in the first year has reduced its 38 person CBO by eight people while adding 12 providers.

We have totally automated hitherto myriad manual processes. For example, we have totally automated take-backs with full balancing within any dataset, across datasets of the same billing system brand and even across different billing system brands and doctors. But the client must let Encoda work. Clients who adopt this system must be willing to suspend their disbelief and abandon some of their most fervently held beliefs.”

Bill Cox, cofounder, Encoda LLC

“Encoda is a game changer. We are thrilled that the US Patent Office understands the significance of our invention, and we look forward to implementing it to materially improve the plight of those beleaguered medical billing units that are willing to discard what, even they admit, does not work well, in favor of something new.”

Robert Lee, cofounder Encoda LLC

Headquartered just outside Philadelphia, PA, Encoda is a software development company that develops and implements a full suite of automation technologies for medical practices. Encoda has one sales person, no administrative assistants, and was founded by, is run by, and 99% staffed by programmers, technologists and systems analysts. Encoda recently founded its own billing service (now called RCM companies), in which it uses its own tools. It provides its software to clients on a hosted subscription basis (today called Cloud Computing and Software as a Service)

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