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
They 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 RCM Analytics (IRIS) Was Chosen To Help Identify Shortfalls
The cardiology clinic heard about Infinx’s RCM Analytics Solution (IRIS) 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 IRIS, which uses machine learning to analyze A/R data by procedures, payers, aging, location and more to identify collection shortfalls and untapped revenue.
IRIS Finds Root Cause And Helps Team Plan For Revenue Recovery
IRIS discovered 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. IRIS 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 and the clinic agreed to move forward with implementing AI-powered solutions to optimize their patient access, denial management and A/R recovery efforts.
Prior Authorization and Eligibility Software (IPA+) Implemented To Help Resolve Patient Access Issues
Our operations team implemented our AI-Powered Prior Authorization and Insurance Eligibility solution (IPA+) to help resolve patient access related challenges while continuing to use IRIS to further investigate A/R leakages.
IPA+ Streamlines Prior Authorization Process with AI & RPA
IPA+ was able to verify the insurance eligibility of patients in real time when they arrived at their appointment. IPA+ used artificial intelligence to cross reference 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 automatically, which saved practice staff hours of being on the phone and in the insurance portals.
The software also tracked prior authorization up until approval using robot process automated status checks and alerting our team of A/R 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.
IPA+’s dashboards display patient information, insurance benefits, patient pay estimates, and status of prior authoirzation claims in near real time.
IRIS Optimizes Revenue Collections With Machine Learning
Our operations team used IRIS’s 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 RCM 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 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
The cardiology practice had a significant turnaround in key financial performance metrics within 3 months, including a $59k increase in monthly collections.
HIGHER MONTHLY COLLECTIONS
Monthly collections increased from
$278K in 3 months to $300K in 6 months
REDUCED AGING A/R
120+ A/R inventory reduced to $ 1.12M, 23.55% of the total outstanding A/R