Customer Situation
A Texas-based mental health and brain view service. The Clinic's revenue cycle systems and procedures have been ineffective in controlling charges and denials, resulting in lower collections.
There were problems throughout the revenue cycle, including a lack of delays in charge approvals because of non-standard workflow, and a lack of comprehensive credentialing processes.
Challenges:
- When an iMagnum team of revenue cycle practitioners and managers investigated the problem, they discovered that the following issues were causing lower reimbursements and higher denials
- Medical records are available in the EHR system, but charges are not posted in the PMS system
- Self-Pay charges not captured in the PMS system.
- Brain view charges have been adjusted without getting payments.
Solutions:
- When the clinic outsourced the processes to iMagnum, we created a comprehensive revenue cycle transformation plan. Our goal was to achieve holistic improvement by addressing all issues with the current state and assisting the practice in growing. Our billers and coders implemented the following solutions:
Charges – Improving the collection
Analysis of the EHR system and identified the Patient got serviced but charges were never billed to the insurance. This was worth 436 charges for $120k. Highlighting the issue on the client end and entering the charges in the PMS system and submitting them to insurance.
Analysis of the EHR system and identified Doctor services completed but CPTs were not marked. Highlighting the issue on the client end and entering the charges in the PMS system and submitting them to insurance.
Compared with EHR and PMS system reports and identified, the Self-pay charge was not entered in the PMS. Highlighting this issue to the client end and entering the charges and billed to the patient.
Physician Credentialing – Denials that should be avoided.
Review the adjustment report and identified the Brain view services were adjusted after the denial. iMagnum team identified that the Brain View CPTs were never included in the credentialing contract for 11 major insurances and initiated the credentialing process for all 11 insurances. As of now, we got payment for these 11 insurances.
Result
- We can see an improvement in collections and a reduction in denials.
- We have increased average monthly collections from $90K to $120K.
