CASE STUDIES
What Our Customers Have to Say
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4DGLOBAL is doing such a great job; we wanted to let you and the team know that your presence and work are acknowledged
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Thank you, VJ, Peter & Team, from my Managers report, the quality is very good. Keep up the good work!
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Great job on the charge batches, thank you.
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We have received several compliments in the quality of your team’s work and the way you handle our accounts. I know everyone is working hard to assimilate many new tasks and accounts into our daily agenda, and I so appreciate the willingness to learn and be flexible without losing speed or accuracy. It is noticed.
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Great! 4D coders are doing an excellent job on the pain coding, so I really think the additional coding jobs should fit in nicely with the other providers.
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My heart is very full today. I’m so pleased to share that all your agents are consistently meeting or exceeding the base goal of claims worked per day. Special thanks to the agents who exceeded the target per day mark, though the efforts of all are so rewarding for me. If ever you need anything from me in order to better recognize and exceed your goals, don’t hesitate to let me know. Otherwise, please accept my gratitude for proving Denial Diminishers as one of the strongest of teams.
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 provider
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
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 provider
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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