Our client is a well established 3 doctor cardiology practice with a state-of-the-art facility in the Houston area. They specialize in treating carotid artery and vein diseases and perform in-house tests and scans, including echos, ultrasounds, EKG and nuclear stress tests, as well as PET scans.
Massive Collection Shortfall With 58% Of A/R Over 120+ Days
Experiencing significant A/R recovery challenges but uncertain of the cause, the practice turned to Infinx to conduct an analysis of their A/R data. Putting the data through our proprietary Revenue Insights Solution (IRIS), we found that they were experiencing a collection shortfall of 37% and with a staggering 58% of their total AR over 120 days due. They also had low reimbursement rates on cardiovascular, nuclear medicine and diagnostic procedures, particularly from commercial payers due to coding errors.
While they had been with their previous billing company for 20 years and were reluctant to switch, IRIS’s identification of the collection shortfall convinced them to act. They partnered with us for end-to-end support of their RCM process.
Infinx IRIS and End-to-End RCM Support Chosen To A/R Recovery
Based on the insights, our RCM specialists could identify specific reimbursement bottlenecks and formulate strategies to address outstanding A/R and undertake RCM process improvements to improve reimbursement rates.
We implemented full scale RCM support, including coding, charge entry, rejections, payment posting, insurance A/R, patient statements and patient calling, and more. Our teams both provided the hands-on effort to get these done and the expertise to optimize the processes.
AROS 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 AROS and evaluate the collectability of outstanding denials and accounts receivable and create a plan for resolution.
Coding Experts Identify Errors Causing Denials
Our coding experts worked closely with providers to ensure documentation and medical necessity supported the codes.
For example, our analysts found a pattern of denials for cardiac monitors due to a lack of authorization and discovered that the practice was submitting authorizations for the wrong CPT code. The in-house staff was able to resolve this issue.
Denial Intelligence Monitor
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.
This module helps identify revenue opportunities and plug revenue leaks. It compares collected amounts by each CPT code with contractual allowed amounts.
$59k Increase In Average Monthly Collections In 3 Months
The cardiology practice had a significant turnaround in key financial performance metrics within 3 months, including a $59k increase in monthly collections.
REDUCED DAYS IN A/R
Days in A/R reduced from 52 days to 30 days
120+ A/R as a % of Total A/R
reduced from 58% to 21%