Specialty : Durable Medical Equipment
Service Offering : Full-Service Billing
Practice Management Software : Brightree
Introduction
This case study examines how a leading Durable Medical Equipment (DME) provider partnered with a medical billing company to enhance their revenue cycle management, resulting in significant operational improvements and financial growth.
Background
The DME provider specializes in supplying essential medical equipment to patients with diverse healthcare needs. Despite their commitment to quality service, they faced challenges in their billing processes, leading to delayed payments and increased operational costs.
Revenue Cycle Challenges
- Inaccurate Documentation and Claims: Incomplete or erroneous documentation led to claim rejections and denials, resulting in substantial revenue loss.
- Manual Data Entry Errors: Outdated manual data entry practices caused billing errors, delaying payments and adversely affecting cash flow.
- Denial Management: Inefficient management of denied claims resulted in lost revenue opportunities.
- Complex Insurance Verification: Delays in verifying insurance details impacted order processing and patient satisfaction.
Objectives
- Enhance Cash Flow: Improve the speed and accuracy of claim submissions to accelerate payments.
- Reduce Denial Rates: Minimize claim denials through accurate documentation and proactive management.
- Streamline Billing Processes: Automate and optimize billing workflows to reduce errors and operational costs.
- Improve Insurance Verification: Expedite insurance verification to enhance order processing efficiency.
Intervention
The medical billing company implemented the following solutions:
- Comprehensive Documentation Review: Ensured accuracy and completeness of documentation to reduce claim rejections and denials.
- Automated Billing Software Implementation: Integrated advanced billing software to eliminate manual data entry errors and enhance operational efficiency.
- Proactive Denial Management: Established a system to track, analyze, and address denied claims, implementing corrective measures to maximize revenue.
- Efficient Insurance Verification System: Implemented a system tailored to DME billing to expedite insurance verification, resulting in faster order processing and improved customer satisfaction.
Results
The intervention led to the following improvements:
| Metric | Before Implementation | After Implementation | Improvement (%) |
| Claim Submission Turnaround Time | 7 days | 2 days | 71% |
| Clean Claim Submission Rate | 85% | 95% | 12% |
| Working on denied Claims | 30% | 10% | 67% |
| Denial Rate | 15% | 5% | 67% |
| Average Payment time | 45 days | 20 days | 56% |
| Monthly Revenue | $500,000 | $625,000 | 25% |
Conclusion
By partnering with the medical billing company, the DME provider achieved substantial improvements in their revenue cycle operations, leading to increased revenue, reduced operational costs, and enhanced patient satisfaction.
