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
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:
- 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.
- 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.
- 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.
- Billing Efficiency: Our improved billing processes and staff education helped reduce claim denials and errors, creating a smoother billing experience.
- Financial Stability: The Texas facility regained its financial stability and was able to continue providing vital substance abuse treatment services to its community.
