Specialty : Family Medicine Clinic
Service Offering : Full-Service Billing
Practice Management Software : E-Clinicals
Introduction
Efficient revenue cycle management is essential for family medicine clinics to sustain their operations and serve the community effectively. This case study highlights the transformation achieved by a Family Medicine Clinic with the support of our specialized medical billing services.
Background
The Family Medicine Clinic, located in Flushing, NY, serves a diverse patient population with a range of primary care needs. With increasing patient volumes, the clinic faced challenges in managing its revenue cycle, leading to delayed payments, high denial rates, and administrative strain on its staff.
Revenue Cycle Challenges
- Delayed Claim Submission: Claim turnaround time was extended, causing cash flow issues.
- High Denial Rates: A significant portion of claims was denied due to coding and submission errors.
- Low Clean Claim Rate: Frequent errors in initial submissions led to additional administrative time in corrections.
- Long Payment Time: The clinic experienced delays in payment due to inefficient follow-up and denial management.
Objectives
- Reduce claim submission turnaround time.
- Improve the clean claim submission rate.
- Optimize denial management processes.
- Shorten the average payment time.
- Increase monthly revenue through more efficient billing practices.
Intervention
Our team conducted a comprehensive assessment of the clinic’s revenue cycle and identified key improvement areas. A dedicated account manager and billing specialists were assigned to implement the following steps:
- Streamlined Claim Processing: We automated and standardized the claim submission process.
- Enhanced Coding Accuracy: A certified coding team reviewed all claims to reduce coding errors.
- Efficient Denial Management: We implemented a systematic approach to identify, appeal, and resolve denied claims.
- Proactive Follow-Up: Focused on consistent follow-ups to reduce average payment time.
Results
The implementation of these strategies resulted in measurable improvements across key metrics.
| Metric | Before Implementation | After Implementation | Improvement (%) |
| Claim Submission Turnaround Time | 10 days | 3 days | 70% |
| Clean Claim Submission Rate | 85% | 98% | 15.3% |
| Working on denied Claims | 45 days | 15 days | 66.7% |
| Denial Rate | 12% | 5% | 58.3% |
| Average Payment time | 35 days | 20 days | 42.9% |
| Monthly Revenue | $150,000 | $190,000 | 26.7% |
