CASE STUDY

End-To-End RCM Services Double Revenue For Texas Gastroenterology Practice

Rising administrative burdens and costs make staying afloat as an independent provider a constant challenge. Still, smaller providers can get streamlined processes, workforce support, and expert guidance that make day-to-day operations manageable and even profitable.

In 2020, our Houston gastroenterology client, was handling charge capture, coding, and billing in-house with serious issues that lead to leaving substantial profit on the table. The practice’s mission is to improve patients’ GI health through a multidisciplinary approach that integrates conventional and functional medicine.

This two-doctor practice has been in the same location for 13 years. Even though the practice enjoyed a reputation as one of the top gastroenterology services in the area, revenue cycle management was an ongoing challenge.

Incomplete Charge Reconciliation Drains Practice Profits

The most challenging obstacles this practice had to overcome were caused by charge capture and reconciliation processing issues.

The Charge capture issues stemmed from doctors procrastinating on documenting the procedures they carried out. For example, gastrointestinal lesions can be addressed using several methods including cold snare, laser, destruction with scissors or scalpel. Each has its own CPT code.

By the time surgical notes were completed, they had forgotten important details of their services like these. Their billing company failed to identify these lapses and the practice was unable to collect all the revenue they were owed.

When, on average, capturing just an additional $100 a day in missed or under-charges adds up to over $25,000 in increased annual revenue, accurate charge capture and reconciliation is of primary concern.

Billing Department Plagued By Coding Errors And Follow-Up Failure

Billing was also a concern. Gaps in the billing process meant a significant portion of services didn’t get billed at all. Once bills did go out, neither in-house staff nor the billing service adequately tracked reimbursements. These failures led to involved procedures and surgeries going to write-offs.

Finally, too often, codes on the bills that did go out were inaccurate due to the staff’s insufficient knowledge of gastroenterology CPT codes. Coding errors led to delays and denials. Serious charge capture, billing, and coding issues left the practice’s revenue cycle in dire need of a robust overhaul.

Enter Expert Charge Capture, Coding And Billing

The practice’s physician-owner evaluated several revenue cycle management solution vendors. Another Houston-area gastroenterologist who had success with our solution recommended us for comprehensive revenue management services.

Once the practice owner selected us, she asked us to begin the next day. She signed with us to handle end-to-end revenue cycle management including charge capture, claims submissions, payment posting, claims denials, rejection and resubmission, accounts receivable management, collections and more.

Careful Surgery Documentation And Coding Execution & Training

Once we began work, our first task was to bring all bills current quickly. Our revenue cycle specialists started capturing all relevant charges and requesting required documentation, ensuring no procedures were missed. In the process, we educated staff on the steps required post-surgery to document events.

We assigned our top gastroenterology coders to their claims to verify for medical necessity and ensure the appropriate documentation was included. These certified professionals ensured they selected, assigned and sequenced the appropriate CPT, ICD-10, and HCPCS codes. Again, during this process, we provided ongoing coding education to their physicians and staff to reduce coding-related denials.

To address the practice’s accounts receivable, we turned to our team of A/R specialists. They performed claims status checks on unpaid claims. For denied claims, they submitted appeals. We handled the telephone inquiries from patients and payers that resulted from our work.

Every week, we send them a weekly spreadsheet of all charges that need to be completed. We are also in communication with them daily to ensure all charges are captured and documentation included.

When the client needed to transition to a new instance of their EHR, we supported them in setting up the system and performing the necessary data entry.

Complete Charge Capture And Coding Doubles Monthly Revenue

Today, we get accurate bills that contain all services rendered out to payers and patients within 24 hours. If something is missing, we are on the phone right away with the practice so that we can get that document and send the bill out. We currently take care of all revenue cycle management with one liaison at the practice.

With our top gastroenterology coders ensuring the right and complete CPT codes appear on claims, the practice’s denials and write-offs dropped significantly. We resolved much of their 90-day+ accounts receivable.

Revenue Cycle Improvements

With improvements throughout their revenue cycle, the practice monthly revenues more than doubled from an average of $80,000 per month to $160,000 to $200,000 consistently. They award us with a 10 Net Promoter score each quarter.

Is your gastroenterology clinic struggling to get paid for all its services? Explore how you can optimize your revenue cycle from end-to-end and maximize reimbursements.

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