Expanding on an already successful relationship, we collaborated with one of the largest national radiology groups to streamline their accounts receivables totaling over $111 million.
As a major player in the radiology sector, this publicly-traded company performs over 8 million outpatient imaging procedures annually. With over 8,600 employees operating in 334 imaging centers in seven states, the organization has complex strategic partnerships with health systems, hospitals, insurance payers, and accountable care organizations (ACOs). Managing these requires finesse and a deep understanding of revenue cycle management.
They offer innovative, industry-first services focusing on quality patient care and state-of-the-art ancillary services. This includes a full suite of radiological services spanning from x-ray diagnostics to interventional radiology. Offering advanced modalities, top-tier technology, and same-day consults with leading sub-specialists in the country, the organization is rated over 91% overall in physician satisfaction.
Unmanageable A/R Amid Growth and Industry Changes
As technology continues to evolve and support more complex and impactful diagnostic and interventional services, reimbursements become more challenging. With changes in the healthcare industry and the growing impact of patient consumerism due to the expansion of High Deductible Health Plans (HDHP) and Health Savings Accounts (HSA), the organization faced increasing financial risk.
In the past, the organization’s regional business offices managed the revenue cycle management (RCM) process from insurance billing through claims denial processing to collections.
As the business grew, so did the accounts receivable (A/R) until it had reached unmanageable proportions. Billing on average $43 million per month, they saw:
- Net collections per month – $36M
- Denials per month – $6.2M
- Net collections rate from follow-up and
- denials – 63.5%
- Average monthly write offs – $2.8M
- Aged A/R >120 Days – 32.9%
Infinx A/R and Denials Chosen Based On A Succesful Partnership
Weighing shrinking margins and the call for effective revenue cycle management from stakeholders, the group needed us to bring tactical solutions for their revenue cycle from end-to-end to proctect their bottom line.
With outstanding results from our prior authorization solution, the organization engaged us to provide comprehensive RCM functions using our state-of-the-art Artificial Intelligence (AI) assisted A/R and denials solution. We made a plan to streamline their accounts receivables of over $111 million.
Machine Learning Prioritizes Claims For Optimal Recovery
By initiating a scalable and reliable platform that uses AI-driven automation supported by certified technicians, our A/R and denials solution was implemented within the organization’s RCM workflow.
With the use of the proprietary prioritization determination engine, machine learningbased algorithms evaluated each outstanding
claim’s recovery propensity and forecasted the next best actions for follow-up and potential denials resolution. Corrections or updates were made, and the claims were then submitted (or resubmitted) through EDI integrations to the appropriate payer portal or clearinghouse for payment.
Our A/R and denials software worked in tandem with certified technicians who handled the complex or problematic claims, while managing them through an electronically generated auto-creation process for appeals letters and faxing.
Root Cause Analytics Target Sources of Revenue Leakage and Patient Access Backlogs
As part of the smart A/R-specific workflow that seamlessly combines human and robotic processes, our solution provided ongoing root-cause analyses.This helped to identify operational areas where improvements were made to eliminate future problems and backlogs in patient access or the coding/billing functions. Our algorithm learns continually and identifies issues which are targeted for improvements such as CPT mismatch, incorrect DOS, missing or incorrect insurance information or benefits.
Group Achieves 28% Increase in Collections and 64% Reduction in Write-Offs
During the initial year, the results were tabulated and evaluated. The organization successfully achieved the following:
With the success demonstrated by our A/R and denials solution, the organization initiated an ongoing engagement with us to handle their A/R process from beginning to end. Coupled with our prior authorization solution, CDSM, and post-service insurance discovery for
uncollectible accounts, the organization has seen significant return to the bottom line for their investment.