How AI & Analytics Helped A Tennessee-Based Radiology Network Collect $14M From 120+ A/R

Operating in fourteen diagnostic imaging locations in Tennessee, a radiology network provides broad-scale 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.

 

A/R Aging Threatened Financial Stability Despite Rapid Growth

The need for collections outpaced the provider’s capacity as the network expanded to become the largest in Tennessee. The A/R team was overwhelmed by 120+ day past-due accounts; the accounting team was quickly facing nearly $10M in rapidly expiring A/R. Time was of the essence with filing and appeal deadlines rapidly approaching. If the 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.

 

Infinx’s ARDM Was Chosen To Help Work Down A/R

The imaging network organized a search for an external RCM partner to meet two critical requirements: the vendor must have: 1) proven experience with A/R and 2) a viable solution backed by an ironclad SLA that included aggressive performance targets, audits, and reporting.

Top decision makers selected Infinx Healthcare for its proven track record in delivering high-quality aging A/R solutions to providers across the nation for more than a decade. They were excited to use our AI-powered A/R Recovery & Denials Management solution (ARDM) to help identify and prioritize claims for recovery.

 

ARDM Finds Root Cause and Drives Reimbursement

With nearly $10 million at risk, finding the source of the denials in the face of looming expirations was urgent. The Infinx team moved quickly to implement ARDM and evaluate the collectability of outstanding denials and accounts receivable and create a plan for resolution.

 

Active Insights From ARDM Interactive Dashboards Drive Action

Machine learning and artificial intelligence analyzed revenue cycle data for display in ARDM to give clear direction on which claims to prioritize for recovery.

 

Denial Analyzer

This module rapidly determined the key source of the client’s aging A/R. Denials were largely due to authorization and medical coding-related rejections.

 

Prediction Module

This module determined which accounts were collectible, which had little hope of recovery, and which ones needed immediate action for revenue recovery.

 

Effort Optimizer Prioritization

This module ranked recoverable and collectible claims to maximize the amount recovered and increase cash flow as fast as possible.

 

RPA Realization

Robotic process automation executes eligibility, claim status checks, and automated support appeals. Infinx’s specialists worked on exceptions and addressed medical necessity queries with relevant medical records to satisfy payer requirements.

 

Infinx solutions managed the aging A/R that was putting our organization at risk. This allowed us to concentrate on our fresh A/R, which has been a key to managing our significant growth – from less than 50 to over 150 providers in two years and simultaneously increasing our collection percentage.

—Billing Director

 

Over $14M Collected with ARDM Within 6 Months & Improved KPIs

In addition to collecting more than $14 million from 120+ day aging A/R inventory in 6 months, the radiology network experienced a dramatic turnaround in key financial performance metrics as shown below.