Controlling insurance AR under 10%

This is a five doctor gastroenterology ambulatory surgery center (ASC) specializing in Upper and Lower GI procedures. The center is equipped with an in-house lab. The doctors also perform procedures in hospitals.

CHALLENGES

• The center struggled with an inflated AR due to high denials, disorganized AR management process
• Use of multiple archaic software systems for ASC billing and procedure billing
• Crucial protocols for upfront patient collections and patient AR were missing
• Difficulty to obtain patient benefits and procedure authorizations promptly causing further denials

SOLUTION

• Transitioned the center to a modern day cloud based practice management system
• Extensively worked on old AR and recovered outstanding payments
• Restructured claim charge amount according to industry standards
• Deployed same day denial management process coupled with regular follow ups
• Identified underpaying TPAs and set up a global agreement for all pathology and anesthesia claims
• Suggested new procedures that could be performed in an ASC setting in a profitable manner
• Patient eligibility and benefits verification 5 days prior to the date of service
• Helped the center setup upfront payment collections process

RESULTS

• Overall insurance AR for the center dropped by 27%. Currently stands below 10%
• AR days significantly reduced from 39 days to 25 days
• Overall collections improved by 23% year on year
• Global agreement resulted in $400K improvement in revenues