SUCCESS
STORIES

Account Receivables - Hospital

Background:

The client is a software developing company specializing in retrieving the underpayments done by the insurance company. Initially Medusind was assigned with loading the contracts in the calc engine through which the system could detect the underpayments done by the insurance companies. Quality in the delivery standards set forth by Medusind prompted the client to outsource the entire RR process.

Key Challenges:

• High AR Outstanding - According to the data retrieved from the calc engine an average of 13% claims were underpaid.
• High AR days -Most of the pending claims were more than 70 days.
• Meager or no follow-up on claims.
• No analysis/ follow-up for underpayments.
• No analysis/ follow-up for denied claims.
• Claims not paid properly due to missing invoice of external devices.
• Unattended ECS rejections.
• Enrollment issues.

The Medusind Approach & Solution:

• Identified the key areas to fix front-end related issues.
• Streamlined clear and accurate approach to demographics.
• Centered on the key issues that resulted in outstanding AR.
• Cleared pending ECS Rejections and technical issues resulting in rejections.
• Daily monitoring of ECS.
• Prompt attention to Denial & ECS rejections processing.
• IVR and AVR technology used to facilitate faster and cleaner processing of claims.
• Regular reporting to Client with value added statistical analysis.

Benefits to Client:

• Increased cash inflow.
• Cleaned up patient and insurance database leading to transmission of clean claims.
• Percentage of underpaid amount being received by the payers increased.
• 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 allocate their staff to new business and functions.

• Back to Success Stories