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End-to-end Revenue Cycle Management – Radiology

Background:

The client is a large Practice Management Company with multiple clients across various specialties. They have outsourced one client specializing in Radiology that has two physicians with an average patient inflow of around 5,000 per month.

Key Challenges:

• Irregular scanning of files.
• No proper documentation of patient information resulted in wrong patient demographic records in the system.
• Defects in Master setup - especially Insurance masters where there was lot of duplicate entries.
• Error in Charges entered.
• HIPAA Edit Corrections left unattended resulting in heavy rejection of claims.
• Unattended ECS rejections. No timely and proper action taken on claims rejected.
• No proper follow-up on claims.
• Payments posted in wrong accounts.
• No proper analysis / follow-up for under payments and denials.
• Denial notes not entered correctly.
• Enrollment Issues.

The Medusind Approach & Solution:

• Identified the key areas to fix front-end related issues.
• Focus on operational efficiency to eliminate unwanted processes.
• Cleaned up the Master Setup files and deleted all duplicate and wrong records.
• Regular updating of Federal Laws and policies.
• Implementation of quality processes for continuous improvement.
• 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:

• Cleaned up patient and insurance database leading to transmission of clean claims
• Analysis and timely action taken on underpaid and denied claims resulted in improvement in collections up to 40%.
• Analysis of denials resulted in fixing key billing issues.
• Systematic Billing system and increase in Cash flow enabled the client to take up an additional location in March 2006 with an average patient inflow of 7,500 per month.
• Increased cash inflow (Client had an average monthly collection of 120K/location before outsourcing. Medusind follow-up approach resulted in 40K - 50K average increase in collections /location for the client. The Total average monthly collection for all the 3 locations is 500K).
• Percentage of claims being received by the payers increased.
• Client was able to allocate their staff to new business and functions.

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