Achieving Strategic Growth through Optimized Operations

This is a three doctor dermatology practice specializing in general and cosmetic surgery procedures. As a newly setup practice with single physician, the practice was keen on strategic business expansion and were particular about building streamlined operations.

EXPECTATIONS

‣ Getting credentialed with all major insurances.
‣ Verifying visit related patient information before the date of service.
‣ Same day claim submission with high accuracy.
‣ Timely denial tracking and maintaining practice performance reports.

SOLUTION

‣ Credentialing: We initiated the credentialing process on behalf of the practice by identifying top insurances, filling relevant application forms, document consolidation and regular follow ups. We shared the credentialing status with the practice regularly.
‣ Adding new location: We helped the practice with the administrative requirements involved in opening new practice location by contacting all major carriers and updating new practice address to avoid payment disruption.
‣ Coding: Created insurance specific coding guidelines to revalidate procedure compatibility and modifier usage, prior to submission of claims. This resulted in high clean claims submission and better first pass ratio.
‣ Performance tracking: We introduced a web based performance tracker sheet. Summary of claims submitted, payments received and denials were update daily. Bifurcated billing/charges summary report of all three providers with their cosmetic and medical procedures was shared with the practice regularly.
‣ Process optimization: We implemented a daily denial management process reduce the reconciliation time to two days. Realtime eligibility and benefits verifications utilities were used for walk-in patients. We devised patient collections plan and sent outstanding balance statements to patients daily.

RESULTS

‣ The practice successfully expanded, currently housing three physicians and three assistants.
‣ Closed 90+ insurance AR at 3% at the end of 2015 (industry average for 120+ insurance AR is 12%).
‣ Completed credentialing for all three providers.
‣ Average collections increased from $50K to $220K.
‣ AR days maintained between 23 to 25 days.