7-Location ENT Group Curbs Revenue Leakage With A/R Follow-up And Payment Posting Services

Patient payments travel a long road before getting to the provider’s bank account. Only tightening up all tasks in the process from the point of scheduling to retrievals accelerates billing and triggers steady revenue.

Timely A/R follow-up and payment posting act as first alerts to revenue leakage. They flag payer denials for medical and prior authorization necessity, as well as non-covered services. Once identified, quick resolution keeps cash flowing so the practice can perform efficiently, and patients are not inconvenienced. AR follow-up and payment posting also uncover errors so they can be rectified and help the team improve.

7-Location ENT Practice Had Enough With Frequent Denials

Of course, the first indication that something is broken in A/R is a high denials rate. When one seven-location Arizona ear-nose-and-throat group’s denials started soaring, they asked us how we could help. This group, centered in the southwest, offers sleep, allergy, and hearing, in addition to the typical ENT treatments.

We had started providing patient access services to this group several years before this point. At that time, within a matter of months, we:

• brought their prior authorization backlog current,
• provided timely and streamlined eligibility and benefits verification services, and
• implemented real-time robust patient pay estimation solutions.

The healthcare staffing shortage played a large role in this group’s decision to outsource their patient access services to a proven partner. Our three years of work demonstrated how we streamline processes, stop revenue leakage, and help clients avoid hiring new FTEs.

Patient Calls, Payment Posting, Statements And A/R Follow-Up Too Much For Two A/R Staff

With abundant opportunity in their area, this client was regularly adding physicians. More physicians mean more revenue, but also more claims. Leaders knew they would need to clean up their backend billing processes to capture the revenue coming in from rising patient demand.

When this client asked us what we could do to lower their denials rate, we examined every aspect of their back-office accounts receivable process. We quickly discovered just one person was working payment posting, statements, and incoming patient calls. Payments that came in two to three weeks before were NOT being posted in the system. Because there was no way this staff member could post payments regularly, a backlog was building. Similarly, they had just one person handling their accounts receivable coming in from seven locations. This individual had little time for AR follow-up. Their 60-, 90- and 120-day buckets were full.

Group leaders wanted to get these denials and aging AR under control to establish their long-term solvency. After all, payment reconciliation issues often lead to delays in month-end closing and mismatched monthly revenue reporting. Incorrect denial postings can lead to inflated outstanding balances in A/R. Accountants–and investors and potential acquisition targets–want to see robust, clean balance sheets.

Group Chooses Infinx For Payment Posting And A/R Follow-Up

With mutual goals of finding sources of back-end revenue leakage and reducing denials, we organized a team of posting experts to evaluate their existing payment posting and AR follow-up processes. Our staff also provided immediate support for AR and payment posting staff.

Once they provided access to their EMR, we began to analyze their accounts and payments. Our team collected the most up-to-date EOBs from payers over the phone and through portals to confidently facilitate the two critical revenue capture tasks.

Working with the group’s staff, we found sources of leakage and implemented changes in the posting and A/R processes.

Accurate Coding Proves The Last Piece Of The Revenue Puzzle

Impressed with the improvements to their posting and A/R, they reached out to ask whether we could help code their claims more accurately. Specifically, they were looking for coders with ENT experience. While we didn’t have that at the time, we let them know that we would search for one, employ them ourselves, and put them on their case. When our new specialist revealed skill in charge entry in addition to billing, we offered those services to the client as well. They accepted.

Backing The Group Up With Hard-Won Industry Expertise

As with all customers, we currently meet with the client’s specialists and practice leaders weekly to share the status of each scope of work. Our presentations include our findings of what’s working well and what could be done better. They commonly ask us how they can improve, and how we can help with those improvements.

For instance, recently they wanted input on improving charge capture and billing conducted by their team. We arranged a call with the group owner and the CEO of Infinx subsidiary Enhanced Revenue Solutions. Today, we promptly share which payer is denying and why. We discuss with their coders and, together, determine how the claim should have been handled. In this way, we help improve their team’s skill and accuracy.

In another example, the group owner wanted to know whether their physicians’ habit of billing Medicare three times the amount it allows was effective. Since we could show how often these claims got rejected (requiring staff time to resubmit) we advised against this practice.

Payment Posting & Coding Backlogs Eliminated. Time In A/R Shortened

Now, when payments come in, they are posted the following day. All are current and the backlog has been eradicated. Their aging accounts have decreased significantly. For coding, once our ENT specialist got to work on their two to three weeks’ backlog of uncoded claims, they cleared the backlog quickly, and all claims are now current.

Overall, the client reports that they’ve seen great progress. Their outstanding claims are getting resolved and their denials worked faster. They are very happy with our work, the clarity they now have in their processes, and the revenue improvement we’ve helped them achieve.

If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.