Client : A multi specialty clinic in Dallas.
Background :
This Clinic was looking for a business partner who could bring in the business back in track, meet delivery and quality SLAs. So, they decided to outsource the AR Management to MDCP. The client engaged found that many of the physicians were becoming dissatisfied with their existing outsourced partner, as they were unable to handle the AR. This was becoming a major reason for doctors not being paid. There was a fear that they might lose some of their physicians if the erratic quality of work delivered was not improved immediately by their billing team. Collections were falling, appeals and actions were not taken on denials and rejected claims and follow up calls were not being made on time.
Objectives & scope :
The scope of the project involved taking over the AR management (old and new). Follow up on recently submitted claims. The client lay down specific goals with respect to:
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• A high level of quality.
• Clear up old AR and Improve collections
• Status and prediction reports on daily, weekly and monthly basis |
Solution :
The following measures were taken to improve quality :
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An effective training model was put in place and a continuous training and feedback was given to the team.
Calls were monitored and feedback document maintained for each Caller.
A quality audit ensured all called accounts pass through a quality check phase, which has 24hrs turnaround time and error accounts routed back to callers. |
The following measures were taken to improve collections and productivity :
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Maintenance of a production plan
Leaders were given metrics based on Productivity, Quality, Delivery, Cost, and are reviewed weekly. (Targets vs. Actual)
Follow up on denied claims and take the necessary action.
Address issues with insurance company and get them resolved.
Maintain knowledge base of issues and solutions.
EOB processing, denial management and rebilling
AR follow-up with payers and patients
Collections, statements, letters, calls, and bad debt management
Up-to-date reporting of billing, collections, and metrics
Maintenance of patient relations |
Results :
MDCP came up with the following key results:
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Increased revenue for the clinic by 30% on account by clearing old AR.
Self -pay got reduced from 18% to 9%.
Decreased denial write-offs as a percent of net revenue by 15%.
MDCP was able to demonstrate improved collections and better quality to the client.
Reduced turnaround time to resolve denials.
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