Category: Case Study

Overview:

This case study unravels the intricate challenges faced by a healthcare organization, encompassing overcoding, credentialing issues, unpaid codes, unprocessed copays, and inconsistencies in patient statements.

The Problem:

The organization grappled with overcoding, credentialing challenges, unpaid codes, unprocessed copays, and inconsistencies in patient statements.

The Solution:

1. Implemented a streamlined coding process to address overcoding issues.
2. Revamped credentialing procedures for enhanced accuracy.
3. Implemented a robust system to ensure all codes are processed, and copay discrepancies are promptly addressed.
4. Introduced a systematic approach to rectify inconsistencies in patient statements.

The Results:

1. Successfully resolved payment issues related to CPT codes 99254 and 99255 with Medicare for initial visits.
2. Achieved a notable 40-50% reduction in rejection rates.
3. Corrected ICD codes during a comprehensive Medicare audit, ensuring compliance and accuracy.
4. Marked increase in average monthly profit by $15,000.
5. Calculated RCM cycle error rate at an impressive 5.97%.

Conclusion:

This case study illuminates the successful execution of multifaceted solutions, addressing overcoding, credentialing challenges, unpaid codes, copay discrepancies, and inconsistencies. The tangible results underscore the organization’s commitment to optimizing revenue cycle management, showcasing improved financial outcomes and operational efficiency.

Revolutionizing Efficiency and Revenue in Internal Medicine

Overview: 

Our client, a Board Certified Internal Medicine Physician in Florida, faced operational challenges in their primary care practice. From Prior Authorizations to Patient Scheduling, they needed a solution to handle high patient volumes while maintaining quality care.

The Problem: 

The practice struggled with critical processes like superbill verification, billing, and payment procedures, requiring a comprehensive intervention.

The Solution: 

We took a holistic approach, addressing Prior Authorization challenges, improving Copay management, optimizing Patient Scheduling, and enhancing insurance coverage verification. Collaboration with Votion played a key role in advancing provider management.

The Results:

1. NDC Claim Denials Prevention: Robust systems prevented denials, resulting in a yearly payment increase of $1008.
2. Man-Hour Savings: Efficiency gains with a significant reduction in COPAY (252 hrs) and PRIOR AUTH (252 hrs), allowing staff to focus on value-added tasks.
3. RCM Error Rate Reduction: Successful reduction to 4.8%, indicating improved financial accuracy.
4. Provider Collaboration: Integration with Votion fostered seamless coordination among healthcare providers.
5. Increased Monthly Profit: Implementation of Way2Cloud led to a monthly profit boost, reaching nearly $5000.

Client Success: 

Notably, with just three months of collaboration, our interventions have optimized operational processes, resulting in substantial financial benefits, significant time savings, and improved provider collaboration. This case study demonstrates how, even in a short period, targeted interventions can drive efficiency and profitability in healthcare practices.

Enhancing Nephrology Practice Efficiency Through Tailored Solutions

Overview:
A North-Florida based nephrology practice encountered significant challenges in patient payment collections, managing denials, and maintaining operational efficiency. This case study explores the identified issues, the implemented solutions, and the subsequent positive outcomes.

Problem:
The medical practice grappled with delayed payments, increased accounts receivable, and operational inefficiencies due to challenges in copay and denial management. This resulted in heightened man-hours devoted to administrative tasks.

Solution:
Robust Strategy Implementation:
Addressed challenges with a comprehensive strategy tailored to their needs.
Daily Eligibility Verification (E.V.):
Ensured doctors start their day with updated patient information.
Proactive Patient Appointment Scheduling:
Significantly reduced man-hours, optimizing operational efficiency.
Denial Prevention:
Achieved a remarkable outcome by preventing approximately 95% of denials.
Increased Monthly Average for Doctors:
Contributed to a noteworthy monthly increase for doctors, exceeding $40,000.
Commitment to Impactful Solutions:
Underscores dedication to providing sustainable solutions for the healthcare sector.

Result:
The implementation of these solutions led to a transformative impact on the nephrology practice:
Financial Stability:
Drastic reduction in delayed or incomplete payments, contributing to improved cash flow and reduced accounts receivable.
Operational Efficiency:
Substantial decrease in man-hours dedicated to administrative tasks, allowing doctors to focus more on patient care.
Denial Mitigation:
of denials by 95%, showcasing a significant improvement in claims processing and reimbursement.
Financial Growth:
Noteworthy increase in the monthly average for doctors, exceeding $40,000, demonstrating the effectiveness and financial impact of the implemented solutions.

This success highlights our commitment to delivering tailored and impactful solutions, ensuring our doctors continued success in the challenging landscape of healthcare.