Expanding on an already successful relationship, Infinx collaborated with one of the largest national radiology groups to streamline their accounts receivables totaling over $111 million utilizing the Infinx RCM Platform with AR Optimizer (AROS).
Partnering With A Leading Radiology Organization
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). Each requires finesse and deep knowledge in reimbursement management.
The organization offers innovative, industry-first services focusing on worldclass patient care and state-of-the-art ancillary services, including 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.
The Increasing Financial Risk
As technology continues to evolve and support more complex and impactful diagnostic and interventional services, collecting on reimbursement owed becomes more problematic. With the changing reimbursement landscape in the healthcare industry and the growing impact of patient consumerism due to expanding 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.
Over time, as the business grew, so did the accounts receivable (A/R) until it had reached unmanageable proportions billing on average $43 million per month:
- 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%
Enlisting an Experienced Partner
Having already had outstanding results after incorporating patient access functions, including prior authorizations, the organization further enlisted Infinx to provide comprehensive RCM functions using their state-of-the-art Artificial Intelligence (AI) assisted RCM Platform. Weighing shrinking margins and the call for effective revenue cycle management from stakeholders, the group needed Infinx to bring a tactical solution to full scale RCM further improving the organization’s bottom line.
Implementing Infinx’s A/R Optimizer Solution
By initiating a scalable and reliable platform that uses AI-driven automation supported by certified technicians, Infinx’s A/R Optimizer Solution (AROS) was implemented within the organization’s RCM workflow.
Using a proprietary prioritization determination engine, ML 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.
Infinx’s AROS system worked in tandem with certified technicians who handled the complex or problematic claims and follow up while managing them through an electronically generated auto-creation process for appeals letters and faxing.
As part of the smart A/R-specific workflow that seamlessly combines human and robotic processes, AROS provided ongoing root-cause analyses, which helped to identify operational areas where improvements were made to eliminate future problems and backlogs in patient access or the coding/billing functions. This root cause analysis learns continually and identifies issues that were then targeted for improvements such as CPT mismatch, incorrect DOS, missing or incorrect insurance information or benefits.
How AROS Impacted the Radiology’s Process
During the initial year, the results were tabulated and evaluated. The organization successfully achieved the following:
- Overall increase in collections from A/R follow-up and denials was 27.9%
- A/R recovery was maximized through high dollar recovery identification only possible through the proprietary authorization determination engine
- Additional reimbursements from aged A/R >120 days was 53.3%
- 90% of denials were addressed in less than 5 days
- Year-over-year improvement of the 120+ A/Rs was 58%
- Reduction in overall write-offs was 64%
- Year-over-year improvement of the 60+ A/Rs was 29.5%
With the success demonstrated by the Infinx AROS, the organization initiated an ongoing engagement with Infinx handling their A/R process from beginning to end. Coupling the RCM Platform with A/R Optimizer and advanced analytics with the Infinx prior authorization solution, the CDSM component, and insurance discovery for uncollectible amounts due, the organization has seen significant return to the bottom line for their investment.
The importance of collecting the maximum reimbursement allowed has never been more important as revenue is under even more pressure than ever before. Through intelligent robotic process automation supported by human expertise, Infinx is bringing smart prioritization and predicted recovery into the RCM toolbox to streamline A/R management and increase revenue for healthcare organizations.