Transformational Revenue cycle results for a Florida based Multispecialty Physician group practice
Customer Situation
Our client is a 500+ physician group practice, facing difficulty in managing the billing turnover time, improve claim lag period and with stacked Account Receivables with no or limited attention.
Lack of adequate resources, expertise and monitoring led to high Account receivables outstanding and lost revenue.
The Physician group submitted claims delayed due to the lack of understanding of the billing guidelines and also with inadequate resources led to a high timely filing denials and increased denial rate.
These factors led to many pending claims and associated amounts across payer groups across different aging buckets. The physician group had not received timely payments for over months and was left with outstanding AR high and uncollectable.
At this time, Annexmed took over the revenue cycle processes, the practice saw about 12,000 patients with an average charge amount of $500 and average payment of $320 each month.
Challenges
At Annexmed, the team conducted a practice assessment that determined the extent of loss in revenue and potential for improved collections. AnnexMed found the practice to be operating 30% less efficiently than its physician peers at the state and national levels.
AnnexMed determined the practice was leaving an estimated $6 million uncollected annually. A key factor contributing to the accounts receivable losses boiled down to a disorganized billing and collections process. We identified the following issues –
- High A/R balance with commercial payers
- A high percentage of Untimely filing denials and aged A/R
- First pass rate less than 90%
- AR days greater than 65 days with 42% of total AR more than 90 days
Solution
To resolve the Billing turnover and A/R situation, our team focused on the following areas
- Deployed a dedicated team of Certified billers, coders, A/R follow-up staff & account manager.
- Updated documentation requirements and billing guidelines of daunting federal and state insurance
- Adopted a payer-specific & bucket-wise A/R approach.
- Implemented Robust processes for timely claim submission.
Result
With increased expertise in billing and coding guidelines, identification of essential problems in the A/R buckets, our team created a sustainable Robust process for improved collections.
- Increased First Pass Rate to 94%
- Decreased Denial % by 4.5%
- Days in AR reduced to 41 days
- Reduced AR>90 days by 21%
- Increase in Net Collection Ratio 96%