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Maximizing Revenue, Minimizing Errors
How SETWorks Helps SpArc Philadelphia Bill Nearly $10 Million a Year with Accuracy
About SpArc
SpArc Philadelphia is a family of organizations benefiting people with disabilities. It includes The Arc of Philadelphia, an advocacy organization; SpArc Services, a day service provider; and SpArc Philadelphia, which manages the administrative side of the two organizations.
Services: Employment Services, Community Services, Day Programs
Company Size: 125 employees
Participants: 1,500 individuals
Location: Pennsylvania
“SETWorks has been a crucial tool for us to be very strong financially and to have a good grasp on compliance.”
Nofre Vaquer // Chief Operating Officer // SpArc Philadelphia
Challenges
Streamlining billing and simplifying compliance
On any given day, the SpArc Philadelphia family of organizations serves over 1,500 people with disabilities through its employment, advocacy, community inclusion, and cultural enrichment services.
As is often the case for disability service agencies, SpArc Philadelphia used a variety of different program management platforms over the years.
“A lot of things were getting lost, or people didn’t put the right thing. For example, they didn’t know what to put when making daily activity records,” Nofre says.
Worse yet, the labor-intensive claim submission and reconciliation process left a lot of room for errors — including opportunities to misplace or forget units of service provided.
“For every 100 units we used to provide, we were able to bill and get paid for about 80,” recalls Nofre.
So when Pennsylvania overhauled its fee-for-service (FFS) system in July 2017 and added dozens of new service codes, Nofre and SpArc CEO Laura Princiotta knew that the new requirements would be unmanageable with their existing processes and technology.
“Laura and I quickly realized that with all these changes coming up, we needed to find a strong software system and a good partner to help us,” Nofre recalls.
Nofre interviewed eight different software vendors around the U.S., but everything he found was complicated and would take too long to train his staff — many of whom are not computer-savvy.
Things all changed when a colleague recommended SETWorks.
Solution
A software system built for the IDD industry
Nofre immediately clicked with SETWorks’ co-CEO David Lindell, and their initial conversation he said was very encouraging.
After seeing a demo of SETWorks, Nofre and the rest of SpArc’s management team were sold. What stood out most was how easy it was to use the system.
SpArc began implementing SETWorks a few months before the fee-for-service changes went into effect. The SETWorks team worked closely with SpArc to understand and solve for the new state requirements. Through it all, Nofre was surprised how involved the SETWorks team was willing to be.
“The state was making all these changes to the payment model, and we were only getting piece-by-piece instructions on how things were going to work. SETWorks still made it all happen,” says Nofre.
SETWorks added a number of options to simplify billing and compliance for Nofre’s team. For example, SETWorks is able to pull in service authorizations from the state HCSIS system. SETWorks also connects to the state’s eBilling system, PROMISe, to send and receive data for electronic billing.
“SETWorks has reduced the number of people that we need to have working on billing, case notes, and management. It has made us more efficient and we have saved a ton of money.”
SETWorks also integrates with the other systems SpArc uses, such as Paylocity for HR and payroll, to further streamline operations and reduce the potential for errors.
SETWorks also integrates with the other systems SpArc uses, such as Paylocity for HR and payroll, to further streamline operations and reduce the potential for errors.
Now with everything in one place, Nofre is able to get a complete picture of SpArc’s performance — something he says is crucial to their long-term success.
“I love being able to go into SETWorks and see what the directors are checking when they’re checking case notes, billing and all those things. “SETWorks keeps me very close to the actual day-to-day operations.”
Results
From 80% to nearly 100% billing success rate
Almost immediately after implementing SETWorks, Nofre noticed an improvement in SpArc Philadelphia’s billing success rate.
This is no small feat for an organization that bills almost $10 million each year. According to Nofre, SETWorks is part of the solution that enables them to maintain such a strong position.
“We have about 125 employees, so that’s a lot of money that each individual bills for us, and it’s all thanks to SETWorks,” says Nofre.
Using SETWorks has also had a positive impact on compliance. SETWorks’ streamlined billing process, which includes automated validation and error-checking, has reduced the potential for mistakes that may lead to billing being rejected. And, should a question ever arise about a claim, SpArc has solid documentation and proof of service data within SETWorks.
“Before SETWorks, there was a lot of room for unintended mistakes that we had to return funds for. But ever since we have been using SETWorks, I can’t remember the last time we had to reimburse the state.”
Looking ahead, Nofre appreciates knowing that whatever new requirements come his way, SETWorks is keeping a finger on the pulse of the industry.
“The SETWorks team is always thinking through the myriad of ways that compliance can be implemented in the system, and most of them are just a flick of the switch away,” says Nofre.
Overall, he is thrilled with SETWorks and never misses an opportunity to recommend it to other providers in Pennsylvania and beyond.
“If I could just go back to 2017, I would save time and not consider any other software and just go directly to SETWorks.”
Does your software support evolving billing and compliance requirements? SETWorks does.
SETWorks comprehensively handles the needs of disability service agencies, across programs, on any device.
Let us show you how SETWorks improves documentation, minimizes billing rejections, and ensures you get paid for every hour you provide.
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