Transitions Care Clinic

Introduction

In today’s healthcare landscape, transition care clinics play a pivotal role by supporting patients as they move from hospital-based care to home or other care settings. However, these clinics face challenges in managing revenue cycles effectively due to the intricate billing requirements for various services, regulatory complexities, and the critical need for accurate coding and documentation. This case study details how I-Conic Solutions LLC helped Transition Care Clinic optimize its revenue cycle, resulting in improved claim success rates, reduced denials, and enhanced financial performance.

Background

Transition Care Clinic, located in Austin, Texas, provides a range of post-acute care services to patients transitioning from inpatient care. Handling hundreds of patients encounters each week, the clinic faced revenue cycle issues that impacted on its cash flow and operational efficiency:

• High Claim Denial Rates: The clinic struggled with denials due to delays in claim submission, incorrect coding, inaccurate eligibility verification, and misdirected claims to the wrong payer.
• Complex Coding Needs: Accurate coding for various post-acute services, therapy sessions, and follow-up care was necessary to ensure proper reimbursement.
• Regulatory Compliance: Adapting to changing Medicare and insurance regulations placed a significant administrative burden on the clinic.
• Manual Processes: The clinic relied heavily on manual billing entry, increasing the likelihood of errors and reducing efficiency.

Objectives

The intervention aimed at achieving the following objectives:

• Reduce Claim Denials: Lower the claim denial rate to below 5%.
• Improve Cash Flow: Shorten the revenue cycle to accelerate payments.
• Enhance Compliance: Ensure regulatory adherence with minimal errors.
• Automate Billing Processes: Implement automation to reduce manual errors and enhance workflow efficiency.

Intervention

To address these challenges, our medical billing company provided a tailored solution specific to the needs of Transition Care Clinic:

• Revenue Cycle Assessment: Conducted a thorough assessment of the clinic’s billing processes, identifying key improvement areas.
• Advanced Coding and Documentation: Integrated advanced coding solutions and delivered targeted training to staff.
• Billing Process Automation: Implemented an automated billing system that synchronized with the clinic’s existing Electronic Health Record (EHR) system, streamlining the billing process and reducing manual errors.
• Denial Management and Appeals: Established a dedicated denial management team focused on efficient claim denial resolution and appeals.

Results

Our intervention led to notable improvements in the clinic’s revenue cycle management metrics: