Pain Management Group
Revenue Leaps by 30%
with Streamlined Claims
Filing.
The Client
The client is a prominent pain management center known for delivering progressive and innovative pain management solutions and empathetic and quality care to patients.
Business Challenges
Healthcare providers often miss filing claims on time due to incomplete or lost superbills also referred to as charge tickets or an itemized list of patient services. Even if the claims are corrected they can be denied when submitted after the expiration of their filing date.
The client faced a similar looming challenge — incomplete/ unlocked patient charts were adding to backlogs, resulting in revenue loss.
The massive backlog of accounts receivable (A/R) and claims not filed on time impacted the prospective revenue growth rate. There wasn’t any standard operating procedure or protocols for tracking visit status, and the follow-ups needed to get claims approved were also limited.
Solutions Delivered
To improve claims filing accuracy, reduce denials, and develop a visit tracking system, the group sought a partner with proven revenue cycle management expertise.
We sat down with the team to review the shortcomings in their current system and examine where we could effectively work to improve revenues and processes.
At first, we analyzed the practice’s electronic health records (EHR) using our proprietary AI-based tool, HealthX and built a consolidated dashboard and data source on Microsoft Power BI, which displayed the status of visits for the group covering all physicians across the facilities. The dashboard was updated regularly and carried all the details needed to get timely follow-ups, including visit data, patient name and the services rendered. It helped to isolate the providers from the locations where they faced the mostchallenges andanalyze which claims are pending, for what duration and the impact they could have on aging and collections.
Regular communication and action were just as significant to avoid potential failure of this customized solution. We encouraged a single point of contact (SPOC) for documentation issues and scheduled weekly calls with daily email communication to track progress.
Strategically, using HealthX we were able to prioritize and divide our attention into two important tasks
Clean the backlog of previous months
Work on the current month
Outcomes
Reduced average
claims pending
ratio by
50%
Processed claims
timely and
improved revenue
growth by
30%
Before VS After
