Texas Cardiology Clinic Increases Monthly Collections $300K With AI And Revenue Cycle Analytics

The client is a well-regarded cardiology clinic with a number of locations in the Houston area, providing treatment for heart and vascular disease. They were looking for a revenue cycle partner to help increase reimbursements for their organization.

Missing Prior Authorizations And Major Collection Shortfall Threatened Financial Stability

Clinic leaders were experiencing lower than expected reimbursements and revenue recovery but were unsure of the cause. They also had challenges with prior authorizations, charge entry and A/R follow up.

Infinx Revenue Cycle Analytics Chosen To Help Identify Shortfalls

The cardiology clinic heard about our revenue cycle analytics and reached out. Once we learned what challenges they were facing, we agreed to help. Our specialists worked with their practice administrator, assistant manager and other team members to input their A/R data into our portal, which uses machine learning to analyze A/R data by procedures, payers, aging, location and more to identify collection shortfalls and untapped revenue.

Analytics Finds Root Cause And Helps Team Plan For Revenue Recovery

Our analytics platform revealed that the client was experiencing low reimbursements for intravenal and cardiovascular surgical procedures. The primary cause of the low reimbursements were denials due to the lack of prior authorizations. The solution also quantified the depressed A/R recovery as a collection shortfall of 19%, caused by a lack of charge entry and A/R follow up.

Based on these insights, our specialists suggested the clinic move forward with implementing AI-powered solutions to optimize their patient access, denial management and A/R recovery efforts.

Prior Authorization And Eligibility Implemented To Help Resolve Patient Access Issues

Our operations team implemented our AI-powered prior authorization and insurance eligibility solution to help resolve patient access related challenges while continuing to further investigate A/R leakages.

Prior Authorization Process Streamlined With AI & Automation

Our patient access solution was able to verify the insurance eligibility of patients in real time when they arrived at their appointment. Artificial intelligence cross-referenced incoming patient information with its national database of payer rules to determine whether an authorization was needed and when necessary, submitted claims for authorization to insurance portals automatic. This step saved practice staff hours of payer phone and portal time. 

The solution also tracked prior authorization up until approval using automated status checks and alerting our team of specialists when necessary to handle exceptions. This human-assisted artificial intelligence approach allowed for 100% coverage of prior authorization cases, requiring practice staff to be involved only when needed to provide additional documentation or engage in a peer-to-peer review.

The patient access dashboard displays patient information, insurance benefits, patient pay estimates, and status of prior authorization claims in near real time.

Analytics Optimizes Revenue Collections With Machine Learning

Our operations team used machine-learning-based insights to identify reimbursement bottlenecks to formulate and execute a plan for collecting the outstanding A/R and denial recovery. This allowed them to discover where revenue cycle process improvements needed to be made to prevent recurring problems.

This module breaks down A/R inventory into segments such as aging bucket, payer and denial code to help RCM teams prioritize claims.

Denial Intelligence Monitor

This module also displays denial trends over time and helps detect anomalies and denial hotspots. It segments by denial code, procedure, facility and payer.

Reimbursement Rates Are Up & Monthly Collections Now At $300K

Within 3 months, the cardiology practice had a significant turnaround in key financial performance metrics, including a $59,000 monthly increase in collections.

If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.