Optimizing overhead costs for a multi specialty surgery center

ABOUT

The client is an established multispecialty surgery center in New York.

CHALLENGES

When the surgery center had staff attrition, they quickly required us to step in and stop financial disruption.

1) Overhead costs ballooned over the years impacting profitability of the surgery center.

2) Operating on a server-based system required that billing be coordinated remotely with minimal disruption to office staff on the front-end.

3) Claims dating back to two years were not submitted to insurance companies.

4) The surgery center faced denials due to lack of timely authorizations. Procedures were performed on patients who were not eligible for service resulting in further financial loss.

WHAT WE DID

Our billing team stepped in to rapidly take control of the situation in less than a month when the center had staff attrition. This required us to quickly grasp the nuances of multiple specialties that the center was billing for, circumvent technology challenges of billing through remote desktops and curb losses due to old claims that were not correctly submitted. Here’s what we did.

1) We established remote desktop connectivity with the center’s existing systems. This minimized transition time but required us to quickly learn how to bill on their system. Operating in a different time zone from New York, allowed us to use the same computers that the center used during their downtime.

2) We analyzed their entire billing and identified a number of old claims that were not submitted or incorrectly submitted. We resubmitted and appealed on required claims – bringing in lost revenues from the past.

3) We established an eligibility and benefits verification process that required capturing patient copays and deductibles. This helped avoid losses through procedures done for patients whose insurances did not cover them.

4) We implemented a process to identify procedures that require authorizations and alert the center so that authorizations can be obtained in time.

5) We setup a separate team to work on the client’s old Accounts Receivable so that revenues from previous billing can be recovered.

LIFE WITH NEXTSERVICES

The center’s primary objective in working with NextServices was to control their overhead costs. Not only did we increase their profitability through a variety of initiatives but also implemented a rigorous billing process that would help stay compliant in the years to come.