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Case Study: How AVA Billing Powered by Medusind Revived Revenue for a Texas Substance Abuse Facility

Background

A Texas-based substance abuse facility was facing a dire financial situation. Having worked with two billing companies unsuccessfully in a span of just one year, it was struggling to collect payments for its outpatient claims. Additionally, the facility had not received a single payment from Blue Cross of Texas for its residential treatment services in over two years due to a contractual issue.

The Texas facility was experiencing both frustration and financial instability as it sought a solution to turn its billing problems around. This is where we stepped in to provide its expertise and support.

Challenges

  1. Unpaid Outpatient Claims: The primary challenge was to address the issue of unpaid outpatient claims. The facility’s previous billing companies had been unsuccessful in collecting payments for these services.

    2. Blue Cross of Texas Contracting Issue: Because the facility was unable to resolve contractual issues with Blue Cross of Texas, it was missing out on substantial revenue from residential treatment services.

    3. Revenue Downturn: The financial instability resulting from these issues had severe implications for the Texas facility’s operations, staff, and ability to provide essential care to its patients.

Our Approach

We took on the challenge of reviving the Texas facility’s financial health with a multi-faceted strategy:

Thorough A/R Cleanup

We initiated a comprehensive accounts receivable (A/R) cleanup process, which involved identifying and addressing claims that had been inaccurately billed or denied, resolving outstanding issues with payers, and following up on unpaid claims.

Contractual Negotiations

We engaged with Blue Cross of Texas to resolve the contractual issues that had hindered payment for residential treatment services. Through skilled negotiations and diligent communication, we reached an agreement and resolved the contractual problem.

Improved Billing Processes

We implemented efficient billing processes, including regular coding audits, to ensure that claims were submitted accurately and in a timely manner. This reduced the likelihood of claim denials.

Provider Education

We educated and trained the Texas facility’s staff to ensure it followed proper documentation and coding practices, further reducing billing errors.

Revenue Maximization

We thoroughly analyzed the facility's fee schedules and pricing to maximize revenue from both private pay and insurance-covered patients.

Results

Our intervention had a significant impact on the Texas facility’s financial stability:

  1. A/R Cleanup: Our cleanup of the Texas facility’s accounts receivable resulted in the successful collection of outstanding claims, providing a much-needed cash influx for the facility.

  2. Blue Cross of Texas Resolution: By negotiating with Blue Cross of Texas, we fixed contractual issues, allowing the facility to receive payments for residential treatment services dating back two years.

  3. Increased Revenue: The Texas facility experienced a remarkable increase in revenue, with a growth rate exceeding 50%. This increase in revenue allowed the facility to invest in improving patient care and expanding its services.

  4. Billing Efficiency: Our improved billing processes and staff education helped reduce claim denials and errors, creating a smoother billing experience.

  5. Financial Stability: The Texas facility regained its financial stability and was able to continue providing vital substance abuse treatment services to its community.

 

In conclusion, our strategic and meticulous approach cleaned up the Texas facility’s accounts and ended long-standing contractual issues, leading to a significant increase in revenue and financial stability. This case study serves shows the importance of effective medical billing and the positive impact it can have on healthcare facilities, especially on those dedicated to helping individuals on the path to recovery from substance abuse.

See how Medusind can work for you

Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.

See How Medusind Can Work for You

Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.

See how Medusind can work for you

Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.