Projects Archive

CHALLENGES

• Expand the practice into a surgery center
• Streamline operations
• Billing conducted in-house
• Gaps in practice management system
• Backlog of 120+ accounts receivable

PROCESS

• Alerted practice on coding changes and denial trends
• 100% patient eligibility two days and authorizations five days prior to the Date of Service
• Insurance follow-up within 15 days of claims submission
• Billed claims within 24-hours of service
• Partnered with the practice to build corporate website and improve marketing and online presence
• Consulted and tracked center’s Meaningful Use compliance
• Co-ordinated with collection agency of the center for collecting patient balances

RESULTS

• Collections increased by $500,000 upon transition
• Global agreement negotiated for anesthesia providers at 92% of fee schedule
• Transitioned practice to a web based practice management system, conducted onsite training
• Reconciled old Medicare claims worth $50,000
• Practice successfully expanded into a surgery center
• Center was able to collect $60,000 as Meaningful Use incentives

“With healthcare reform looming, we look forward to growing together”

CHALLENGES

• Reimbursements fell by $700,000 in 2012
• Difficulty in implementing practice management system (PMS)
• Loss of claims during submission to insurances
• Inadequate reports and management control
• High denials for authorizations and coding

ANALYSIS

• Payment analysis: Reviewed around 10,000 EOBs to establish pattern of payments, reimbursement rates and denial trends
• Billing analysis: Office and facility claims billed under the same Tax ID. The center did not differentiate amongst paid, outstanding and actionable claims
• Software analysis: Identified appropriate software and implemented changes
• Consulted and tracked center’s progress on Meaningful Use compliance

RESULTS

• Collected approx. $2.2M in first 5 months
• Renegotiated contracts by 300%
• Established patient insurance eligibility and authorization process
• Collected approx. $125,000 from patients in first 5 months
• Set up Electronic Fund Transfer utilities to automate and quicken payments
• Center received $90,000 as Meaningful Use incentives

Recouped $250,000 from old AR within first three months

CHALLENGES

• Streamlined RCM process on Day 1
• Availability of patient benefit information
• Prior authorizations 10 days in advance
• Appropriate procedure scheduling
• Technology to transfer demographic data

PROCESS

• Authorizations and benefits/ eligibility done 10 days, 3 days ahead
• Clean-claim submission on day of procedure
• Insurance-based AR follow-up (e.g. Aetna 4 days, BCBS 9 days)
• Tracking insurance payments to patients
• ERA/ ACH payments on same day of deposit
• Patient statements on same day of settlement
• Online bill pay system and automated reminders

RESULTS

• 95% in operational efficiency in audit results
• 94% collection rate (incl. non-par)
• Retrieved $6M+ from patients
• 100% authorization accuracy
• 120+ AR is 6.68% compared to 14% industry average

Negotiation with carriers to increase payment rates from 35% to 82%

CHALLENGES

• Approx. 10M in 120+ AR bucket
• Unresolved accounts dated 4 years back
• Many credentialing related denials
• Incorrect patient demographic information
• No patient eligibility verification process

PROCESS

• Built team of experts for each aspect of process
• Set up process for 100% eligibility check for each patient
• Extensive AR analysis done based on top denials
• Special calling teams deployed to rectify credentialing issues
• Mass appealed on old claims
• Set up patient AR process

RESULTS

• Approx. $1M recovered within 4 months
• Total AR reduced from $9.4M to $5M within 6 months
• Mass resolutions with insurance carriers
• Accelerated payments

OUTSTANDING AR AFTER OUR RECOVERY SOLUTION

CHALLENGES

• Establishing an entirely new lab
• Setting up Practice Management System
• Credentialing with insurances
• Data extraction from Lab Information System (LIS)

PROCESS

• Daily data extracted from LIS for claims submission
• Set up Direct Deposits and Electronic remittance for all possible insurances
• Global agreements established with TPA’s for higher reimbursements
• Sharing billing summary with practice on a weekly basis
• Confirmation of payments (paper checks) prior to reconciliation in Practice Management System
• Setup process for patient account receivables

RESULTS

• Agreements set at 90% of billed amount
• More than 100% increase in samples screened
• Collected approx. $66,000 in Q1 2013 and approx. $100,000 in the first month of Q2 2013
• One of the only two WellCare providers in Greater New York

“Thank you very much to all of you for your wonderful work ”

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