Optimizing the Revenue Cycle for an Urgent Care Client During the COVID-19 Pandemic
Client Overview:
Our client, a high-volume healthcare provider, was facing significant revenue loss due to unresolved Workers’ Compensation and No-Fault claims. Limited follow-ups on denials and delayed appeal submissions by the in-house billing team resulted in missed reimbursements and growing AR.
Challenge
- Massive claim denials due to delayed submissions and coding errors
- High claim volume exacerbated by the pandemic
- Difficulty navigating evolving COVID-related billing guidelines
- Inefficient eligibility verification processes
Solution
To address the crisis, we assembled a team of experienced billers and implemented a comprehensive strategy:
Expert Team Deployment:
Data Analysis Using MGMA Benchmarks:
Proactive Denial Management:
Our billers focused on resubmitting denied claims with corrected information. Detailed appeals were crafted and submitted along with supporting documentation, significantly increasing approval rates.
Insurance Verification Specialists:
We deployed a dedicated team of insurance verification specialists who ensured accurate eligibility checks before claim submissions. This proactive measure reduced errors and improved claim acceptance rates.
Maximizing HRSA Fund Utilization:
Results
Our strategic interventions yielded remarkable outcomes:
- Achieved a success rate of 97% or higher for paid claims
- Drastically reduced claim denials
- Streamlined the revenue cycle, ensuring a steady cash flow
