CASE STUDY

Analyzing​ and ​Implementing Patient Access & RCM Optimization for Radiology ​Group

One of Infinx’s customers, a radiology group, operates in five locations in a medium-sized city in Texas. They offer patients a full spectrum of imaging technologies, from X-rays, MRIs, ultrasounds, CT scans to bone density screenings and advanced mammographies.

Difficulty Finding Qualified Administrative Staff To Handle Their RCM

While the customer had kept pace with providing their teams of board certified radiologists and technicians with state-of-the-art facilities and equipment, their achilles heel was recruiting and retaining qualified administrative staff from a limited local talent pool.

With experienced medical coding, preauthorization and billing skills at such a scarcity within the surrounding area, the customer endured a perpetual administrative backlog—often reflected in unfavorable patient feedback after vital imaging procedures were delayed or incorrectly denied by insurance payors.

After finally conceding that an in-house office staff alone was no longer viable, senior management began searching for a stronger alternative. After evaluating several vendors, they eventually turned to Infinx to implement a custom-tailored, end-to-end RCM solution.

Onboarding Strategy: Filling In The Skills Gaps

  • Insurance eligibility/verifi cation was particularly hindered by the inconsistency of the local talent pool.
  • Prior authorizations lagged behind schedule—forcing rescheduled patient appointments or high-priority procedures to be performed without proper insurance authorization.
  • ICD-10 coding bottlenecks were created where almost 30% of medical records were delayed beyond 48 hours.
  • Payment posting by the in-house team endured a routine 10-15 day backlog.
  • Initially we established an agreed-upon Standard Operating Procedure, which outlined their preferred ‘dos-and-don’ts’ for transactions with specific payors, including Medicare claims.
  • After determining the required manpower resources, we assigned several radiology coding and billing specialists from our existing team, familiarizing them with the customer via online training sessions. Our ramp-up process concluded with initial productivity targets for the first 30 days, with goals increasing beyond the following 30-90 days.

An Added Wrinkle: Simultaneous PMS Migration

Our new partnership with this customer coincided with their planned transition to a new patient management software (PMS) system. Typically a rocky experience in itself, the challenges from this migration were further met by our specialists, who are adept at most standard PMS platforms.

Revenue Cycle Managed

Following our evaluations and initial project ramp-up, results for this customer were positive:

  • Insurance verification and prior authorizations dramatically increased, using our cloud-based Infinx Prior Authorization Software, driven by automation and artificial intelligence, upscaling towards 98+% accuracy of prior authorizations.
  • Daily coding record turnarounds dropped from the previous 20-30% towards our targeted goal of only 5%.
  • Assisted in tackling the customer’s PMS migration was eliminated the previous payment posting backlog.

The administrative issues which had plagued their operations were largely alleviated, leading to satisfied patients and stronger relationships with referring providers.

Let’s Optimize Your RCM Workflow

Schedule a call with our team to learn how our solution can help optimize your revenue cycle.

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