Stopping losses due to compliance

ABOUT

The client is an anesthesia and perioperative services provider based in Michigan with 16+ anesthesiologists working in the field and centralized administration.

CHALLENGES

1) Missed updating CAQH compliance information. The group missed updating their information with the Council for Affordable Quality Healthcare (CAQH), a non-profit alliance that streamlines the business of healthcare. This resulted in ongoing denials.
2) Inconsistent billing submission. As the anesthesiologists kept traveling, it was difficult for them to regularly submit billing information. This increased the risk of timely filing denials.
3) Paper EOBs delayed reconciliation, including secondary balances. Most of the payment information received from insurances was via paper. This delayed reconciliation resulting in late secondary submissions.

WHAT WE DID

The NextServices billing team streamlined the billing process for this group of anesthesiologists, despite various constraints. Here’s what we did:

1) Closing gaps with compliance. We regularized the process of physicians updating information to CAQH and other channels with defined periodicity. This simple process correction resulted in a dramatic drop in compliance related denials. It also helped the group stay compliant with the authorities.
2) Same day billing submission. To control the delays in billing, we submit claims to insurances immediately after receiving them. This reduces lag in submissions and payments. We maintain an insurance Accounts Receivable (A/R days) of 5-7% above 90 days, which is greatly lower than industry average of 14%.
3) Digitizing EOBs. We set up Electronic Remittance Advice (ERA) and other digital systems to get the group reconcile payments electronically. This not only helped them get paid quickly, but also resulted in timely secondary submissions and reimbursements.

LIFE WITH NEXTSERVICES

The anesthesiologists continue to enjoy what they love, the practice of medicine without worrying about getting paid correctly for their work. We take care of that. The administrator does not worry about the challenges of operations because of various systemic constraints. We customized the billing process by circumventing the constraints and maintain outstanding results such as weekly zeroing out of claims and keep A/R 90+ days at 5-7%, much below industry averages.