Location: Oahu, HI

Specialties: Primary care

Number of Providers: 8

Number of Patients Enrolled: 20,000

Median Patient Age: 67

Date: 2022

Introduction

The clinic was seeking ways to optimize its revenue cycle and improve reimbursement by ensuring proper billing for preventive health services. Prior to adopting the Valhalla Platform, many billable preventive health screenings were either missed or insufficiently documented, leading to lost revenue opportunities.

Methodology

• The Valhalla Platform was leveraged to identify and automate the documentation of preventive health CPT and HCPCS codes required to be covered by Affordable Care Act (ACA) health insurance plans.

• The platform targeted key preventive screening codes outlined in the table below.

• Automated workflows ensured proper documentation and code selection, reducing administrative burden and improving compliance.

• The clinic provided claims data exports from the practice management system to verify new claims resulting from Valhalla.

Results

• Over $160,000 in additional potential revenue generated yearly per primary care physician (PCP) by properly identifying and billing for preventive health screenings.

• Automated documentation and coding significantly reduced administrative workload while improving billing accuracy.

• Ensured compliance with ACA-mandated covered benefits, reducing claim denials and increasing reimbursements.

Conclusion

By implementing the Valhalla Platform, the clinic was able to unlock substantial new revenue streams through better identification and automation of preventive health billing codes. This not only improved financial outcomes but also ensured that patients received essential preventive care, reinforcing Valhalla’s role in enhancing both operational efficiency and patient health outcomes.