Urgent Care Practice Billing

Business Challenges

Setup:

• EMR – Electronic Medical record is a new concept.
• Total Accounts Receivables- $ 532K
• Insurance Accounts Receivables – $ 380K of the total AR. 90+ AR % was close to 65%
• Patients Accounts Receivables – $ 152K
• Collections – $ 120K
• AR days was 90 days.
• No denials were worked promptly & there was no proper documentation on denials
• Patients Accounts receivables were totally a mess and no patient’s statements were generated in the proper duration.
• No proper follow-ups were initiated on the claims
• The only advantage is the immediate accessibility to the patient’s medical records.

Appropriate steps handled to reduce the AR:

• Teleconferenced with the client to get a clear insight on how the EMR worked.
• Charge errors were reviewed and billing rules put forth in order for the office to correct their mistakes. The charge errors were mainly due to the inappropriate usage of modifiers, procedure codes etc. So, appropriate coding rules were also formulated.
• Some charges were not filed to the insurance carriers at all, due to some technical snag in the system, which were identified and rectified.
• Electronic Submissions and retrieval of rejected reasons were analyzed in detail and % of rejections was reduced by making the client aware of the mistakes.
• Patient statement schedules formulated and started the process of generating patient statements at regular intervals. At times, all the four bill cycles were audited and generated to avoid increase in AR.
• Patient AR policies were designed to suit the best of this practice.
• The claims that have lesser timely filing limit were identified, their denials analyzed and appropriate appeals handled with the medical records.
• Patient’s co-payments were allocated incorrectly and these were identified and rectified.
• Outdated diagnosis codes kept generating by the system in default, which was identified and fixed with the help of the software team.
• Frequent error reports, missing ticket reports, future appointment cases mailed to client to have a clear track on their office activities, patients flow and missing charges.

Key Achievements

• Current Total AR – $ 155K
• Current Insurance AR – $ 100K
• Current patients AR – less than $50K
• Collections – $133 K – $140K
• Current AR days – 26 days

Highest collections recorded in this account since ICS started handling the account was $ 135 K – 5 months.

Customer Testimonials

1. “Overall I am pleased with the support. The response time and communication is fine. Knowledge about billing and claims is excellent.”