CASE STUDY

How a Tennessee Based Radiology Network Resolved Backlogged 120+ Day Aged Accounts

The largest outpatient diagnostic imaging network in Tennessee operates 14 diagnostic imaging locations throughout the region, providing convenient patient access to over 50 board-certified, sub-specialized radiologists utilizing state-of-the-art diagnostic imaging technology, including PET/CT, MRI, CT, nuclear medicine, mammography, ultrasound, and X-rays.

The Imaging Network Had $9.5 Million in 120+ Day Aged Accounts

As the client’s radiology services grew, its accounts receivable team struggled to keep pace with demand. The A/R team was overwhelmed by 120+ day past-due accounts. These accounts represented a total of $9.5 million. Public and commercial insurance denials constituted 70% of that total. Overturning the denials was a huge challenge.

With filing and appeal deadlines rapidly approaching, time was of the essence. If the imaging network was going to recoup nearly $10 million in potential lost revenue— an outcome that could threaten the organization’s financial stability— it had to find an experienced, proven, and fast solution.

The imaging network organized its search for an external RCM partner with two key traits top of mind: specific expertise and resources for high-volume A/R and a viable solution with an ironclad SLA that included aggressive performance targets, audits, and reporting.

Implementing Infinx’s State-of-the-Art A/R Optimization Software

With a proven track record in delivering high-quality aging A/R solutions to providers across the nation for more than a decade, Infinx quickly deployed its proprietary Timely Expiry Evaluation software to evaluate the collectability of outstanding denials and accounts receivable based on timely filing limits and appeal limits corresponding to the respective payers.

Of the $9.5 million in A/R, more than 70% accounted for denials in the range of 120-365 days from their service date and required further investigation by our denial and A/R specialists to determine their complexity and turnaround efforts for resolution.

With the help of Infinx’s analytics software, the outstanding A/R was easily categorized into public and commercial payers, days to timely expiry, and resolution complexity. This helped determine which accounts were collectible, had little hope of recovery, and which ones needed immediate focus.

Infinx’s Maximum Recovery Prioritization algorithm then formed a ranking order of recoverable and collectible claims—ones whose time limits had not yet expired and that would bring in the most recoverable dollars— this would maximize the amount of recovery. By prioritizing charges for maximum recovery, predicted recovery, the effort required, and operational constraints were all taken into consideration. In addition to superior revenue capture, faster cash flow was another priority for the radiology network. This is why high dollar collectibles requiring very little hands on effort were made a top priority.

Authorization and medical coding related rejections made up the bulk of all denials. Using a meticulously curated database of historical LCD/NCD guidelines, our AR & denial specialists were able to validate the rendered services as a routine/preventive exam or as a diagnostic/screening procedure done in conjunction with a routine/preventive exam.

Infinx’s experienced specialists used best practices to overturn the denials and increase cash flow.

Resolution activities included:

  • Validating subscriber’s eligibility, authorization requirement, and benefits as per Medicare, Medicaid, and commercial payer guidelines
  • Addressing medical necessity queries with relevant medical records as per payer’s satisfaction
  • Reviewing the inclusive procedures and comparing with LCD/NCD guidelines
  • Validating true duplicates and appending modifiers to re-bill wherever necessary
  • Identified trends and root causes affecting preauthorization and other workflows
  • Developed and implemented process improvements for the in-house team to reduce denials and payment delays

Infinx’s appeal automation module helped in the rapid creation of follow-up communication and appeals—the submission process of which was further accelerated by an Infinx custom FTP link to the client’s system which enabled local mailing of appeals paperwork in advance of filing deadlines.

The Significant Improvement to Key Financial Metrics

Infinx’s A/R Specialists Reduced Outstanding Aging AR Within 6 Months

The radiology network experienced a drastic improvement in key financial performance metrics on their 120+ A/R inventory in a quick span of 6 months:

  • Successful liquidation of over $14 million of 120+ day aging A/R
  • 120+ A/R inventory reduced to $2.6 million, which was 11% of the total outstanding A/R
  • The GCR on claims aging 120+ days improved by 140%
  • Collections from 120+ AR/ improved by 95%
  • Accounts were maintained at quality levels of more than 98%

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      1. Loria K. Putting the AI in Radiology. Radiology Today, Vol. 19, No. 1, P. 10.
        https://www.radiologytoday.net/archive/rt0118p10.shtml.
        Accessed on June 7, 2020.
      2. Carlson B. Molecular Diagnostics Market Now Larger than the Economies of 50 Nations, per New Report. Kalorama Information Website. October 30, 2019.
        https://kaloramainformation.com/molecular-diagnostics-market-now-larger-than-the-economies-of-50-nations-per-new-report/.
        Accessed on January 20, 2020.
      3. Atella V, Mortari A, et.al. Trends in are-related disease burden and healthcare utilization. Aging Cell, 2019 Feb; 19(1): e12681. Published online November 29, 2018. doi: 10.1111/acel.12861.
        Accessed June 1, 2020.
      4. Cohen R, Zammitti E. High-deductible Health Plan Enrollment Among Adults Aged 18-64 with Employment-based Insurance Coverage. Centres for Disease Control and Prevention NCHS Data Brief No. 317. August 2018. https://www.cdc.gov/nchs/products/databriefs/db317.htm.
        Accessed on January 24, 2020.
      5. PAMA Regulations, Important Update. CMS.gov, Centers for Medicare and Medicaid Services.
        https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/PAMA-Regulations
        Accessed on January 28, 2020.
      6. 2018 AMA Prior Authorization (PA) Physician Survey. American Medical Association, Prior Authorization Research & Reports. 2019. file:///C:/Users/katem/Downloads/priorauth-2018%20(1).pdf.
        Accessed on November 23, 2019.
      7. Yu Y, MD. Transforming the prior authorization process to improve patient care and the financial bottom line. MGMA, Knowledge Expansion Insight Article, Reimbrusement.
        https://www.mgma.com/resources/revenue-cycle/transforming-the-prior-authorization-process-to-im.
        Accessed June 10, 2020.
      8. Finnegan J. MGMA19: No progress to fix prior authorization, as practice leaders say it’s gotten worse. Fierce Healthcare. October 16, 2019. https://www.fiercehealthcare.com/practices/mgma19-no-progress-to-fix-prior-authorization-as-practice-leaders-say-it-s-gotten-worse.
        Accessed June 8, 2020.
      9. 2019 CAQH Conducting Electronic Business Transactions: Why Greater Harmonization Across the Industry is Needed, p. 2. 2020.
        https://www.caqh.org/sites/default/files/explorations/index/report/2019-caqh-index.pdf?token=SP6YxT4u.
        Accessed on January 30, 2020.
      10. Joint Authorship. Consensus Statement on Improving the Prior Authorization Process. American Medical Association. 2018. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/arc-public/prior-authorization-consensus-statement.pdf.
        Accessed on January 22, 2020.
      11. Letter to the House of Representatives in support of Improving Seniors’ Timely Access to Care Act 2019 (H.R. 3107) from 370 Associations. September 9, 2019.
        https://www.rheumatology.org/Portals/0/Files/Coaliition-Letter-HR3107-Prior-Authorization-Reform.pdf.
        Accessed on January 30, 2020.
      12. Livingston S, Luthi S. House Committee Throws Spotlight on Prior Authorization Burden, Modern Healthcare. September 11, 2019. https://www.modernhealthcare.com/politics-policy/house-committee-throws-spotlight-prior-authorization-burden.
        Accessed on February 3, 2020.
      13. Ibid. 9.
      14. Industry Checkup: Measuring Progress in Improving Prior Authorization. American Medical Association. 2019.
        https://www.ama-assn.org/system/files/2019-03/prior-authsurvey.pdf.
        Accessed on February 2, 2020.
      15. Artificial Intelligence – What it is and Why it Matters. SAS Insights. 2020.
        https://www.sas.com/en_us/insights/analytics/what-is-artificial-intelligence.html.
        Accessed on February 1, 2020.
      16. Siwicki B. At RadNet, AI-fueled Prior Authorization Tech Shows Promise, Healthcare IT News, Global Edition. May 6, 2019. https://www.healthcareitnews.com/news/radnet-aifueled-prior-authorization-tech-99-accurate.
        Accessed on January 6, 2020.
      17. Napco’s iBridge Technology Named Top Innovation of 2014 by Security Sales & Integration Magazine – Recurring Revenue Model Makes iBridge a Top Choice for Security Dealers. January 13, 2015.
        http://investor.napcosecurity.com/2015-01-13-NAPCOs-iBridge-Technology-Named-Top-Innovation-of-2014-by-Security-Sales-Integration-Magazine.
        Accessed on February 3, 2020.
      18. Integrating Prior Authorization Solution with Epic PMS While Protecting PHI at a Pennsylvania Hospital Group. Infinx Case Study. 2018. https://www.infinx.com/resourcecasestudy/integrating-preauthorization-solution-with-epic-pms-lt/.
        Accessed on February 2, 2020.
      19.  Implemented a Complete Overhaul of Revenue Cycle Management Program for Large Hospital-Owned Cardiology Clinic. Infinx/Enhanced Revenue Solutions Case Study. 2018.
        https://www.infinx.com/resource-casestudy/implemented-a-complete-overhaul-of-revenue-cycle-management-program-for-large-hospital-owned-cardiology-clinic/.
        Accessed January 12, 2020.
      20. Ibid. 9.
      21. *******Chhaltralia V. What Does the Future Hold for Artificial Intelligence? Industry Analysis and Graphic, AI Business. March 22, 2018. https://aibusiness.com/industrygraphic-artificial-intelligence/.
        Accessed on February 2, 2020.
      22. Maximize Hospital Revenue with a Holistic Insurance Discovery Strategy. January 7, 2019.
        https://revcycleintelligence.com/news/maximize-hospital-revenue-with-a-holisticinsurance-discovery-strategy.
        Accessed on January 20, 2020.
      23. How Using Insurance Discovery Can Significantly Improve A/R, Infinx Blob. January 23, 2020.
        https://www.infinx.com/blog/how-using-insurance-discovery-can-significantlyimprove-a-r/.
        Accessed on January 23, 2020.
      24. 2018 Survey of America’s Physicians: Practice Patterns and Perspectives. The Physicians Foundation, Empowering Physicians/Improving Healthcare. 2019.
        https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf.
        Accessed on January 30, 2020.
      25.  New Findings Confirm Predictions on Physician Shortage. Association for American Medical Colleges. April 23, 2019. https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage.
        Accessed on February 1, 2020.
      26. Reporting appropriate use criteria in claims for Medicare Patients. American Medical Association. August 17, 2020.
        https://www.ama-assn.org/practice-management/medicare/reporting-appropriate-use-criteria-claims-medicare-patients.
        Accessed on August 19, 2020.