CASE STUDY 1

A Mental health & substance abuse service provider located in New York, USA

Managing AR rejections/denials proved to be a vital task for a growing number of reasons. The client had to tackle issues like:

  • Claims filed to incorrect payers which affected the TFL & Appeals
  • Claims are not being filed to IPA directly
  • Timely filing has exceeded, etc

All these made the claims process slow and had an impact on provider’s revenue

Challenge :

Collecting the maximum revenue within the minimum time period. The foremost challenges were to identify the appropriate timely filing limit

  • Identify the appropriate appeal limit
  • Evaluate the extent of a global issue which had an impact on other accounts
  • Understanding the importance of documentation

Solution :

To address problems in specific workflows we tried the following:

  • Identify the correct payer to avoid incorrect filing
  • Rectify errors with the correct insurance information
  • Cross-check for errors across different accounts of the client’s health system

Once these were identified, rectified & addressed, we developed a customized solution to the client and ensured to send an update on the global issues periodically in order to bring quick revenue to the providers

Benefits :

With the help of our services the client was able to see the following changes to the AR process:

  • Simplified AR work flow
  • Correct rejections/ denials with up-to-date matching with information
  • Reduce returned claims by 10 – 15% with accurate processing of insurance information
  • Improve collections and payments by 15 – 20%
  • Reduce risk levels
  • Reduction in stress level of employees at client end

CASE STUDY 2

An Anesthesia & Pain management service provider located at Indiana, USA

Challenge:

The client was managing 500+ claims per month, and faced stiff billing challenges for the following reasons:

  • Errors due to incorrect patient information/ provider credentialing etc
  • Errors due to incorrect/mismatched/absent codes
  • Documents - Errors due to inappropriate medical records (Patient/ provider)

On top of these the client often had to contend with issues like poor documentation and duplicate billing and as a result decline in collections. So, the client approached us to make major changes to improve their AR

Solution :

We took the following initiatives to improve the productivity and collections of AR:

  • We provided the client with a dedicated team and account manager to handle the provider's account
  • We developed an effective AR process and medical billing process to ensure the level of AR process is maintained
  • We addressed various issues with multiple insurance companies in order to get them resolved

Benefits :

Our clients were able to access see the following benefits with the solutions we offered:

  • We brought down the average AR days by 15%
  • We increased collections by 10 – 15% percentage
  • As we are into complete RCM, our client were able to concentrate on other areas for increasing business
  • Accounts backlog were kept under control
  • We maintained a balance on both quality & quantity and ensured this was maintained throughout the RCM process

CASE STUDY 3

A Family Practice service provider located at Indiana, USA

Large unattended denials and increased AR

Challenge:

To analyze and reduce major denials faced by our denial team

  • Detail review of the denial management system
  • Identify the commonly occurring denials & prioritizing to address within the appeal limit
  • Evaluate the extent of a denial which impacts revenue
  • Understanding the importance of documentation

Solution :

We took the following initiatives to improve the collections of AR & reduce the denials

  • We analyze the reports month on month and compare the denial ratio
  • Find out the root cause of the problem so that the same type of denial does not occur in future
  • Identifying the GLOBAL ISSUES so that the action on 1 claim results in action on several other claims
  • Ensure the AR does not go out of control
  • Our team addressed issues with the insurance company and got them resolved within the turn around time

Benefits :

Our clients were able to see the following benefits with the solutions we offered:

  • Every denied claim was appealed quickly and well before the time line for making the appeal
  • Reasons for denials, rejections and low payments were investigated and we made sure the appropriate corrective and preventive actions were taken
  • EOB’s & other resources were utilized properly to track the appropriate denial and actions were accordingly
  • We were successful with payments from older aged payments from several payers
  • Decreased backlog of denials

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