Case study:
Full-Service Revenue Cycle Management
Client Profile
Location:
NYC
Specialty:
Endocrinology
Services Deployed
Revenue Cycle Management
Overview
Our Client’s former outsourced RCM company was underperforming with a lack of denial and AR
management resulting in high Days in AR and %AR > 90 days. Over 800 UnitedHealthcare claims
were pending medical records review, up to 1 year old.
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Our Clients’s patient invoicing problems were resulting in overwhelmed office staff and dissatisfied patients.
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SCALE was engaged to respond to UnitedHealthcare requests as well as review coding to eliminate error rates and prepayment reviews.
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Additionally, we were tasked with maximizing collections on old unworked claims to be completed, providing feedback to the practice on individual insurance guidelines to minimize denials and loss, maximizing claims throughput and providing ongoing proper insurance denial and AR action.
Execution
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SCALE developed a tracker for projects and client dashboard that we reviewed with the Client on a weekly basis.
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We provided a temporary increase in resources to send outstanding medical records for pre-payment review and work old AR.
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SCALE researched the root cause of denials and created custom claim scrubbing rules to fix claims prior to submission.
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We provided feedback to the practice on insurance specific guidelines resulting in claim denials.
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SCALE trained the practice to properly track and close open charts and outstanding claims.
Results
SCALE was able to achieve the following on
behalf of our Client:
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Outstanding Medical Record Requests reduced by 68% in 2 weeks.
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Reduced insurance rejections pending action by 100% in 2 weeks.
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56% reduction in appointments without claims in 4 weeks for year to date: 100% reduction for 2021.
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Identified and billed $875k in gross charges over 30 days old not billed by former RCM team.
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Represents approximately 80% of 1 month of billing.
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SCALE helped practice retrain providers and created weekly tracker to help manage unclosed charts.
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$81k payments for 2021 service in 4 weeks.
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$100k payments for claims over 45 days old in 4 weeks.
SCALE was able to bring the Client immediately up to date on ongoing Medical Records Requests and all claims and payments are current and up to
date. The Owner has noticed a significant increase in number and frequency of payments and we
are expected to see a 10% increase in practice revenue. We estimated $250,000 in recovered
collections from aged claims (2/3 of 1-month).
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.