Consulting at a surgery center

CHALLENGES

• Reimbursements fell by $700,000 in 2012
• Difficulty in implementing practice management system (PMS)
• Loss of claims during submission to insurances
• Inadequate reports and management control
• High denials for authorizations and coding

ANALYSIS

• Payment analysis: Reviewed around 10,000 EOBs to establish pattern of payments, reimbursement rates and denial trends
• Billing analysis: Office and facility claims billed under the same Tax ID. The center did not differentiate amongst paid, outstanding and actionable claims
• Software analysis: Identified appropriate software and implemented changes
• Consulted and tracked center’s progress on Meaningful Use compliance

RESULTS

• Collected approx. $2.2M in first 5 months
• Renegotiated contracts by 300%
• Established patient insurance eligibility and authorization process
• Collected approx. $125,000 from patients in first 5 months
• Set up Electronic Fund Transfer utilities to automate and quicken payments
• Center received $90,000 as Meaningful Use incentives

Recouped $250,000 from old AR within first three months