Cardiovascular Group Reverses Collection Shortfall & Increases Monthly Collections With AI & RCM Specialists

BACKGROUND

A successful Houston-based cardiology group with a state-of-the-art facility specializes in treating carotid artery and vein diseases. They perform in-house tests and scans, including echos, ultrasounds, EKG and nuclear stress tests, as well as PET scans.

Experiencing significant A/R recovery challenges but uncertain of the cause, the practice turned to Infinx to conduct an analysis of their A/R data using Infinx’s proprietary tool, RCM Health Check.

CHALLENGE

37% Collection Shortfall and A/R Challenges

RCM Health Check revealed that they were experiencing a collection shortfall of 37%, with a staggering 58% of their total A/R over 120 days due. The practice also had low reimbursement rates on cardiovascular, nuclear medicine and diagnostic procedures, particularly from commercial payers due to coding errors.

SOLUTION

End-to-End RCM Support Chosen For A/R Recovery

While they had been with their previous billing company for 20 years and were reluctant to switch, Infinx’s identification of the collection shortfall convinced them to act. Based on RCM Health Check insights, Infinx revenue cycle specialists identified specific reimbursement bottlenecks. They also formulated strategies to address outstanding A/R and RCM process enhancements to improve reimbursement rates.

Infinx implemented full scale end-to-end RCM support, including coding, charge entry, rejections, payment posting, insurance A/R, patient statements and patient calling, and more. A hands-on approach and cardiology expertise helped expedite the process.

ARDM Finds Denials Root Cause and Drives Reimbursement

With nearly $10 million at risk, finding the source of denials in the face of looming expirations was urgent. The Infinx team moved quickly to implement A/R Recovery & Denials Management (ARDM) technology, allowing them to quickly evaluate the collectability of outstanding denials and accounts receivable and create a plan for resolution.

The ARDM denials intelligence module determined that denials were largely due to authorization and medical coding-related rejections. The shortfall detector helped identify revenue opportunities and plug revenue leaks. It compared collected amounts by each CPT code with contractual allowed amounts.

Cardiology Coding Experts Identify Specific Errors Causing Denials

Cardiology coding experts worked closely with the providers to ensure documentation and medical necessity supported the codes.

For example, Infinx analysts found a pattern of denials for cardiac monitors due to a lack of authorization and discovered that the practice was submitting authorizations for the wrong CPT code. The in-house staff was able to resolve this issue.