The client is America’s leading provider of mobile bedside diagnostic services across the post-acute continuum of care. The company has 12,000 post-acute and correctional facilities across 46 states and provides mobile radiology catering to more than 7,000 facilities located throughout most of the United States. They specialize in mobile radiology (X-ray and ultrasound), laboratory, cardiac monitoring, vascular access services, and on-site nurse practitioner-based primary care.
Executive Summary and Scope
A national leader in mobile radiology had accumulated over $25 million in 60+ day AR inventory—which was more than 40% of their total AR. With their growing AR days outstanding and limited staffing resources, the client was looking for a two-fold remedy. First, they wanted an immediate solution to resolve the growing backlog of claims denials and rejections. Then, second, a longer-term strategy to partner with an experienced revenue cycle management organization able to meet the growing needs of their business.
Eligibility Denials Accounted for 40% of the Total A/R
The client was facing an acute situation of aging AR and lost revenue due to eligibility-related issues and claim edit rules for charges related to hospice, assisted living, skilled nursing, and patient home services.
With a limited workforce, the client was not able to keep pace with the rework required, which led to an increase in DFNBs (discharged, not final billed), FBNSs (final billed, not submitted), untimely filings, appeals, and subsequently huge write-offs. Eventually, unbilled charges and eligibility denials for 60+ day AR inventory totaled about $25 million—constituting more than 40% of total active AR.
A/R and Denials Specialists Used Analytics Software to Devise a Two-Pronged Strategy
Having extensive experience dealing with varied coverage inadequacy scenarios, Infinx’s AR and denial specialists used proprietary analytics software to segment the AR inventory into various eligibility rejection subtypes, and claim edit scenarios. They were also able to study the trends across payers, service facilities, and patient demographics.
After segmenting the AR inventory and understanding the relevant data, Infinx was able to devise a two-pronged strategy that included:
- Prioritizing and pushing DFNBs through the appropriate clearinghouse to the payer for reimbursement
- Using their proprietary Recovery Predictor and Next Best Action Determination Engine to prioritize, correct, and resubmit all denied claims
Infinx’s A/R Optimization Solution Improved Collections of >60 Days Aging A/R Within 4 Months
Medicare and most commercial payers have strict filing timelines—usually less than 90 days from the service date. With Infinx’s proprietary TFL-TAL software, our AR experts evaluated the risk of revenue leakage by payers and state locations and prioritized the set of DFNBs that required immediate rectification and billing activities.
Eligibility and Claim Edit Activities
Inefficient synchronization of patient management software between hospitals and physicians was leading to incorrect payer mappings and missing or incorrect patient demographics. Using Infinx’s AR Optimization Solution, the prioritization module analyzed the eligibility rejection sub-reasons and denial trends to produce a ranked work order of claims for the denial specialists to pursue.
In the process, Infinx also undertook activities pertaining to configuring and rectifying claim edit rules after conducting regression studies on payer rejection trends. Infinx’s AR and denials specialists then took overall AR resolution activities and were able to overturn the denials in record time.
Significant Improvement to Key Financial Metrics
The radiology provider saw a drastic improvement in key financial performance metrics in their 60+ day aged AR inventory within four months:
- Reduced active 60+ day aged AR inventory related to DFNBs, FBNSs and eligibility rejections by 64%
- Reduced all eligibility denials from 40% to 24%
- Resolved $18 million of 60+ day aged AR and generated $4.48 million in payments
- Improved gross collections from eligibility rejections by 28%