Case Study: How AVA Billing Powered by Medusind Revived Revenue and Rebuilt Billing at an Adolescent Mental Health Residential Facility
Background
An adolescent mental health residential facility that needed financial recovery and billing overhaul reached out to us for help. We were initially engaged for a billing department evaluation, but then we uncovered severe issues hurting its operations. The facility’s Director had been outsourcing tasks to external entities, while the in-house claims team was inadequately trained. Failure to file claims in a timely manner had resulted in the potential write-off of over $4 million in claims. In addition, the facility was under pre-payment review with their largest payer, Anthem, adding to the financial strain.
Challenges
- Outsourcing and Lack of In-House Expertise: The Director’s outsourcing of crucial tasks and the claims team’s inadequate training had left the facility in disarray, with massive claims write-offs looming.
- Timely Filing Issues: Over $4 million in claims were at risk of being written off because the team had failed to submit claims accurately and in a timely manner, including failure to submit correct facility NPI information.
- Pre-Payment Review with Anthem: The facility’s largest payer, Anthem, had placed it under pre-payment review, causing further delays in receiving crucial funds.
Our Approach: Claims Recovery and Financial Stabilization
We embarked on a comprehensive approach to rescue the facility’s finances and rebuild its billing processes:
Claims Recovery
We launched a thorough review and recovery effort, successfully salvaging 50% of the claims that were on the verge of being written off.
Anthem Pre-Payment Review Resolution
In just four months, we cleared the pre-payment review hurdle with Anthem, releasing over $3 million in past-due funds.
Process Enhancement
AVA Billing improved the facility's medical record documentation processes, ensuring that claims were submitted accurately and on time.
Revenue Optimization
We increased the facility's revenue by an impressive 45%, optimizing fee schedules and maximizing collections from both private pay and insurance sources.
Denial Rate Reduction
By improving billing practices and staff training, we decreased the denial rate to under 10%, ensuring a higher rate of successful claims.
Accelerated Payment
The time to payment was reduced to an average of 21 days, significantly improving the facility's cash flow.
Our Approach: Consulting and In-House Team Development
With revenue stabilized, we initiated a consulting agreement, focusing on developing a high-performing in-house billing team:
Hiring & Training
We played a pivotal role in hiring and training a new in-house billing team, ensuring it was well-prepared to handle complex billing tasks.
Standard Operating Proceedures (SOPs)
We established detailed Standard Operating Procedures to guide the new team, promoting consistency and efficiency.
Ongoing Audits & Support
We conducted quarterly audits to ensure the new team adhered to established processes. We also acted as a subject matter expert, providing support when needed.
Results
Our intervention transformed the adolescent mental health residential facility:
Claims Recovery and Financial Stabilization:
- Financial Rescue: Our efforts saved over $2 million of the $4 million in claims that were at risk of being written off.
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- Anthem Pre-Payment Review Success: In just four months, we successfully cleared the pre-payment review with Anthem, releasing over $3 million in past-due funds.
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- Significant Revenue Increase: The facility’s revenue increased by an impressive 45%, providing much-needed financial stability.
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- Denial Rate Reduction: With a denial rate now under 10%, the facility enjoyed a higher rate of successful claims.
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- Faster Payments: The time to payment was reduced to an average of 21 days, improving cash flow.
Consulting and In-House Team Development:
- The Establishment of a High-Performing Team: Our consulting efforts created a proficient in-house billing team that could operate at a higher level.
