Our client is a very well established cardiovascular clinic that has three separate locations in Houston, Texas. While employing only six physicians, they see a client volume equivalent to that of a practice twice their size.
However, they were leaving a considerable amount of revenue on the table due to their stagnant A/R. There were also large gaps in their billing process, leading to missing claims and reimbursements. Due to their existing billing vendor’s lack of capacity and expertise, our client’s revenue cycle was badly underserviced and in need of repair.
They received a referral to us from CardioVascular Care Providers, a renowned cardiovascular consortium in the area. The cardiology practice signed on with us for our end-to-end cardiology revenue cycle management services due to our reputation as a highly reliable cardiology revenue cycle billing company among top providers in this consortium. Our services include coding, payment posting, patient statements and calls, charge capture, claims submission, A/R rework, and denials management.
Expert Charge Capture And Medical Coding Increases Average Billing Per CPT
Our revenue cycle specialists got to work and were able to capture all relevant charges and documentation from their complex in-patient and outpatient services, ensuring no revenue was missed. Our cardiology certified coders stepped in to verify claims for medical necessity and ensure appropriate documentation was available. Appropriate CPT, ICD-10, and HCPCS codes were selected, assigned and sequenced.
We were able to identify a pattern of EDI-related claims denials and correct the cause of these errors in our client’s EHR. We’ve also provided ongoing coding education to their physicians and in-house staff to reduce coding-related denials and revenue leakage going forward.
Within a year of taking over this account, we were able to collect over 100% of our modeled Medicare collection percentage. With appropriate up and downcoding, the client can bill more on a per CPT basis.
RCM Overhaul Brings In Additional $160,000
To address the client’s A/R buildup, we deployed a team of A/R specialists. Our teams carried out claims status checks on unpaid claims, and appealed and resubmitted denied claims as needed. We also managed refund requests and helped to manage write-offs in coordination with the client. Finally, we handled all telephone inquiries from patients and payers regarding any processed claims and patient statements.
Within a year of working with us, the improvements to their revenue cycle workflows created a $160,000 monthly improvement in their collections, bringing them from $810,000 a month to $970,000 a month with the same CPT code volume.
Surgical Pre-Collection Workload
And Denials Reduced By Patient Access Automation-Assisted Workflow
Assured by these results, they decided to expand their involvement with us to their front end. They were seeing lots of denials on complex electrophysiology prior authorizations and enlisted us to provide pre-collections services. This included insurance eligibility verifications and benefits checks as well as prior authorizations.
Once patient and service details are entered into our web portal, our solution uses direct payer integration where permitted to determine eligibility in real-time. When a payer isn’t electronically accessible, our insurance specialists call and verify, ensuring complete coverage.
After this, our authorization determination engine takes over to determine if an authorization is needed, using a national, regional, and local database of payer rules. When needed and permitted, our solution automatically submits an authorization to the payer. Otherwise, our prior authorization specialists manually initiate the case with the payer. Regular status checks occur and the practice is alerted peer-to-peer or additional documentation is required.
The combination of these services immediately lead to a decrease in denials and further improved cash collections.
Collections Doubled With End-to-End RCM Optimization And Technology-Enabled Patient Access Plus Solution
Today, three years into our partnership, they have doubled monthly collections to $1.6 million with the same number of staff and only the addition of an onsite PET scanner as an additional revenue source.
We’ve worked in partnership with the cardiology clinic to systematically clean up and optimize every aspect of their revenue cycle, from their patient access to coding education to A/R follow-up in order to achieve these results.
Incorporating our Patient Access Plus solution for their surgical eligibility verifications and prior authorizations has considerably reduced their in-house staff’s workload and reduced claim denials. With the improvements to their coding, they consistently collect 117% of Medicare modeled amounts on their claims monthly.
They’ve also been able to see a major improvement in their customer service workflows with patients. With our dedicated customer support staff and the full-time A/R specialist on their accounts, we answer any questions from payers or patients on their monthly billing statements, removing the burden of this on their office staff.
The practice’s expert medical providers can focus on providing top-quality patient care while knowing their revenue cycle functions are being handled with high-quality expertise that will result in the maximum reimbursements for them.