Optimized Revenue Cycle by Resolving Billing Delays and Poor Collections

Introduction

We received a request from a clinic to review & optimize their RCM as they are struggling with poor collection and delay in the billing.

Challenges

When IDS starts receiving the data, we divided into four sections Billing, Coding, AR & IT and reviewed the gaps in all areas to optimize it. In our review we identified the below challenges

• We found a lag in the charge date and billed date which indicated the delay in uploading of demographics and charge data.
• We Identified a high rate of duplicate denials and on further review it indicated that duplicate charges were entered in the system and there was no mechanism to track it.
• We identified the issue with coding as there were outdated instructions were being followed.
• Due to Lag in billing the AR days was 53 days, inconsistent monthly collections and high denial rate.
• The payment posting lag was high and there was a backlog.

Our Solution

With this deep dive analysis, the IDS team improved revenue cycle KPIs of the clinic by

Reducing the Charge Entry Lag

• IDS provided the education to the front office on managing the delays in turnaround time for demographic and charge information’s.
• IDS provided the improved mechanism to upload the patient information and charges which resulting in the reduction of the lag.

Improved Clean Claim rate

• IDS provided the education on the coding challenges by introducing the effective edits and billing guidelines on impacted procedures.
• We provided the cardiology specific coder (CCC) to improve coding quality.

Improved AR Days & Denial sanitization

• IDS fixed their charge entry lag & payment posting lag which improved the ARDays.
• IDS provided education & mechanism on front end issues which were the major causeof denial.

Payment posting optimization

• IDS reviewed the payment posting mechanism and found that there is a lag in the posting and process is mostly manual.
• IDS setup the electronic mechanism to automate the payment posting for high frequency payers.

Result

• Days in AR reduced to less than 40.
• Reporting structure was updated. A cadence of weekly, bi-weekly, monthly & quarterly reports was implemented to ensure that timely decisions could be taken to prevent any revenue leakage.
• Use of certified cardiology coder improved the coding accuracy above 97%.
• Charge entry backlog was cleared and mechanism implemented to avert in future.
• Front end denials were significantly reduced by 58%.
• Dedicated documentation handling & appeals team was formed to improve the appeals quality which yielded improved collection on appeals & timely submission of documentations.
• Payment posting automation were done for high frequency payers reduced the payment posting lag.

Below is the KPI Metric when we reviewed and after the changes were implemented by theclinic.