Skip to content

Case Studies

An illustrative selection of SCALE Consulting case studies.
Case study:

Coding Performance Oversight – Primary Care

Client Profile

Size:
40 Providers

Location:

Dallas/Ft. Worth, TX

Specialty:
Primary Care
Nephrology
Transplant Medicine
Cardiology
GI

Services Deployed

MSO & Practice Integration

Post-Audit EducationService Title

Revenue Cycle Management

Overview

Our Client consists of one high volume practice with four specialties. The Client is an active
participant in government/commercial payer initiatives to deliver value-based care. They had not
implemented a robust coding and clinical documentation program and recognized this as a key
strategic area for performance improvement.

SCALE was engaged to build and manage the practice’s coding and clinical documentation ongoing
monitoring, provider training, and education program.

Execution

  • Together with with Scale RCM, we collaborate with our Client to determine the audit focus each quarter, i.e. particular types of claims or payer practice.
  • We audit each provider in the practice once a quarter.
  • We provided additional remediation for providers that fell below a certain performance threshold.

Results

  • SCALE provided strategies to assist our Client in providing clearer documentation & decrease confusion about DX addressed on each DOS.
  • We captured services that require specific documentation elements to be billable and mitigated the risk associated with documentation deficiencies.
  • We implemented a recurring, ongoing program for monitoring and improving performance.
  • Through our assessments, we provided ongoing training and education to all providers in the practice to facilitate best practice in coding documentation.
  • Across the provider team we identified a subset of providers with lower scores/room for improvement, and implemented/augmented reviews, training, and education for the subset.

At re-audit, increased score due to incorrect documentation for audio-only telehealth. After
implementing recommendations, achieved 100% score. Improved 23% then 37% over past quarter.

Solve for the Missing MSO Pieces

Let's SCALE together

SCALE Healthcare is based on the foundation of a singular focus – elevating management performance across healthcare services. We are focused on the entire suite of operational advisory and diligence services exclusively to healthcare service organizations, with local team presence across 10 states.

Unlike the many consulting firms that offer more narrow and often more impractical solutions borne of limited or very general expertise, we rely on our team of 75+ carefully selected senior operational healthcare experts to ensure we provide the most relevant and value added experience across the full range of management disciplines and clinical specialties that fall within healthcare services.

Contact us to continue the conversation.

Sign up for SCALE Healthcare
Leadership Conference