SUCCESS
STORIES

Account Receivables

Background:

The client is a large Physician group specializing in Radiology with group practice clients throughout the East Coast. Each group averages 5-7 physicians. Initially Medusind was assigned a part of the AR follow-up process limited to denial verification. Quality in the delivery standards set forth by Medusind prompted the client to outsource the entire end-to-end AR follow-up process.

Key Challenges:

• High AR Outstanding - According to the 2003 RBMA study the average AR outstanding for claims aged 31-60 days was 18%, while for the client it was in excess of 23%. Aging of other claims was 5% higher than RBMA standards.
• 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.
• Poor demographics upload quality from front-end (Hospitals).
• 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.
• Resolved enrollment related issues.
• Cleared pending ECS Rejections and technical issues resulting in rejections.
• Setup "Online" facilities with major payers processing 30% of total claims addressed online.
• 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 (Client had an average monthly collection of 2 million before outsourcing. Medusind's follow-up approach resulted in 250K - 500K average increase in collections for the client, an increase of 12% in net collection bi-annually).
• Cleaned up patient and insurance database leading to transmission of clean claims .
• Percentage of claims 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.

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