Optimizing Revenue Cycle Management: A Multi-Site Urgent Care Case Study

The Client: Multi-Site Urgent Care Organization

The client is a multi-site Urgent Care organization in North Carolina. They opened with a software vendor who provided them with a good EMR software solution that they felt would fit their business model and they were also able to bundle in other essential services such as their contracting, credentialing, and Accounts Receivable management services. It appeared to be a good solution at the time.

This client opened well before a Pandemic was even a possibility. They were steadily growing their organization with high hope for their continued success. While they were having some issues with the vendor, it was not enough to force them to attempt to cancel their agreement at that time. Once the Pandemic appeared on the scene, like many other organizations, they were in survival mode.

Problems Faced by the Client

Within 2 years of contracting with the vendor they were finding issues with their credentialing and contracting processes which limited their ability to treat certain patients and/or require patients to pay a higher out of pocket after the fact. Additionally, the vendor make a major change to the software which forced them to move to a new A/R management platform which in turn affected their Accounts Receivable workflow. 

Soon, patients and employer clients began complaining. Cash Flow started decreasing and the A/R started climbing with no real resolution in sight. Multiple discussions regarding the issues occurred, however no resolution was in sight.

With the Pandemic in full swing, the Client could not afford to continue to operate in this manner, so they decided that they needed to place their Contracting, Credentialing and Accounts receivable with an outside agency. They began searching for assistance in key areas in revenue cycle management to help build a better cash flow and in collecting the outstanding AR that has now accumulated. The client was looking for a reliable accounts receivable service provider to help them out with their problems. Some of the problems they were facing include:

  • Denials were handled without any kind of proper analysis
  • No preventive measures were being carried out by them
  • There was no proper documentation and escalation for these AR cases

Client ultimately chose Medical Practice Success as their RCM partner.

The Challenges

  • Majority of the AR volumes was already beyond the timely limit and had little to no follow-up documentation to assist with appealing the claims
  • Claims were coded incorrectly and there was a very large backlog of claims that needed to be recoded and rebilled
    There was no proper documentation and escalation for these claims therefore it was difficult to categorize claims for ease of working them. They truly had to be worked 1:1 to determine the next logical action.
  • Many clams were dropped to patient responsibility without an explanation, and we had to stop patients’ statements for well over 4 months to go through several thousand statements to clean up items incorrectly billed to patients. This included items such as posting errors, provider credentialing denials, etc.

Our Solution

Keeping in mind the client’s challenges, problems, and their specific requirements, the following solution was devised by our expert team:

  • Have one team focused on getting new claims coded and billed timely, rejections worked timely, and any denials resolved timely.
  • Do not let the new AR fall behind while we worked the old AR.
  • Have the other team focused on the rest of the AR. It was decided that the AR would be split based on the age bucket and highest/lowest dollar category then further drilled down by payor and contract type. This would help us to prioritize the AR based on the severity of the situation and allow us to utilize the best team members for the task.
  • Trends and patterns would be identified to help collect money in the case of bulk denials.
  • There would be proper training provided for documentation and escalation. This would help in consecutive follow-ups to understand them and take the required corrective measures without failure.
  • Where we could utilize automation to identify incorrect payment posting errors or timely filing issues, we leaned into this process with a sample audit to validate findings/actions.

The Results

Medical Practice Success ensured that all the project processes ran smoothly according to the plan. Some of the key results achieved during this project include:

  • The denials at the client’s end were categorized and the accounts dispositioned.
  • All provider credentialing errors were corrected and the Managed Care contracts that were not properly obtained were completed, and the client has been able to accept a larger population of patients in their local area.
  • Retraining and education provided to the entire client front end regarding identifying payor hierarchy when multiple plans are present and understanding insurance verification processes.
  • Job Aids and training materials have been generated for future references to avoid any kind of unnecessary follow-up or appeal
    Reduction of non-credentialing/non-contracted denials reduced by 77%.
  • Reduction of timely filing denials on all new claims reduced by 84.7% and we were able to appeal and recoup over $210K in prior timely filing denials by submitting appeals and second level review requests.
  • Patient and Employer billing inquiries reduced by 73% within initial 10 months and remains at less than 75 calls per month.

Choose Us for Efficient Healthcare Accounts Receivable Services

Medical Practice Success has been providing top-quality healthcare accounts receivable services and a plethora of other services to clients in the United States for years. We ensure that the healthcare provider is paid on time for every claim and experiences an increase in revenue. Our cost-effective services will ensure that your company’s cash flow is improved and that you are satisfied with our services, which is why we have a guarantee. Reach out to us for a free consultation.