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Revenue Cycle Performance Improvement

The Problem

Despite being financially successful, a ten (10) physician orthopaedic practice was leaving millions of dollars in accounts receivable uncollected every year. Upon completion of a preliminary practice assessment, it was determined that the practice was writing off in excess of $2 million dollars a year as a result of a failure to appeal denied claims, meet timely filing deadlines, and improper submission of claims. More than 30% of the A/R outstanding was at least 150 days past due, and the practice was taking an average of 45-60 days to post charges.

The Solution

The following is a sample of the many initiatives that were utilized to improve the financial and operational performance of the practice:

  • Recruited additional billing & A/R management personnel and reorganized the billing department to accommodate additional staff and an influx of volume;
  • Redesigned all front desk operations and implemented protocols for collecting all patient demographics and appropriate fees: self pays, co-pays, deductibles (if applicable), non-covered services and patient balances;
  • Implemented a daily review to monitor that charges are posted daily and claims submitted within 48 hours of the date of service;
  • Redesigned the accounts receivable collection processes;
  • Implemented systems to appeal all denied claims within 72 hours of receipt of rejected EOBs (explanation of benefits); and
  • Created and implemented a skills assessment test for billing department personnel as part of a performance appraisal initiative.

The Results

During the twelve (12) month revenue cycle performance improvement engagement, the MDmanagement consultants achieved the following results:

  • Increased total charges 36%
  • Increased annualized net collected revenue more than $1,300,000
  • Decreased accounts receivable more than 27%
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