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Account Receivables - Dental

Background:

The client is a leading Dental Practice Management Company that outsourced its Account Receivables for of the last four years (2002-2005) to Medusind. This client, with more than 50 clinics, had asked Medusind to recover "outstanding dues and monies" from patients and carriers.

Key Challenges:

• High AR Outstanding - According to a study the average AR outstanding for claims aged 31-60 days was 18%, while for the client it was in excess of 38%. Aging of other claims was 7% higher than industry standards.
• High AR days -Most of the pending claims were more than 120 days.
• Claims filing time limits were exceeded.
• Clean claims were not submitted to the carriers.
• No required support documentation attached when filing claims.
• Meager or no follow-up on claims.
• No analysis/ follow-up for underpayments.
• No analysis/ follow-up for denied claims.

The Medusind Approach & Solution:

• Identified the key areas to fix front-end related issues.
• Focused on the key issues that resulted in outstanding AR.
• Accomplished Eligibility and Benefit Verification procedures prior to submission of claims.
• Attachments/EOBs related to particular claims were submitted through online National Electronic Attachment (NEA) services.
• Cleared Pending ECS Rejections and technical issues related to previously submitted and denied claims.
• Prompt attention to all denied claims including ECS rejection processing.
• IVR and AVR technology used to facilitate faster and cleaner processing of claims.
• Utilization of trained collection agents who negotiated and recovered dues and payments from patients.
• Regular reporting to Client with value added statistical analysis.

Benefits to Client:

• Increased cash inflow (Client had provided us with accounts, which they had decided to write off. Medusind's follow-up approach resulted in $ 320K increase in collections of such claims for the client over a period of 90 days).
• Cleaned up patient and insurance database leading to transmission of clean claims.
• Percentage of clean claims submitted to carriers increased significantly.
• With more clean claims being submitted, the timely filing limit is minimized, resulting in increased cash flow.
• Subscription to online payer services resulted in timely verification of patient demographics, submission of claims to payers and statements to patients.
• Analysis of denials resulted in fixing key billing issues.
• Client was able to re-allocate their staff to new business and functions.
• Days in AR have been brought within industry standa.

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