Medical Billing Case Study
Elevating Allergy Care: Expertise and Personalized Solutions
At Billed Right, we specialize in expert medical billing services tailored for allergy specialty health practices. Explore how our customized billing solutions optimize operations, reduce denials, and ensure financial stability for our clients in the allergy healthcare sector.
Location:
Winter Park, Florida
Specialty:
Allergy
Providers:
2
Locations:
2
Our Client
Background
- A practice providing Allergy services to patients, utilizing cutting edge technologies and a multi-disciplinary approach to allergy and immunology health.
- To achieve this purpose, they use an array of treatments, including allergy injections, pulmonary testing, and asthma treatments.
- Like many practices, physicians do not have the time to focus on billing operations and hardly have time for patient care.
- However, there comes the point where these physicians realize they need outside professional RCM help. This practice had outsourced billing to a 'one-man' billing operation.
Turning to Billed Right
When they contacted us, they discovered that we are experts in their EMR and PMS.
An onsite meeting was conducted, allowing us to gain a deep understanding of their workflow and provide tailored recommendations. We also completed and presented a comprehensive billing audit, which highlighted several issues and areas for improvement.
The Office Manager realized that significant flaws in their existing workflow were hindering their ability to grow and continue practicing effectively. With expertise in both billing and their specialty, as well as familiarity with their EMR, they decided that outsourcing to Billed Right was the right step to address their operational flaws.
Challenges
Their Struggle
The following were the key pain areas the practice was grappling with:
Coding was split between 50% on paper superbills and 50% in the EMR.
Physicians' documentation was never reviewed to audit documentation vs. billing.
There was no tracking for allergy injections
There was an inability to properly code co-morbidities.
Lack of coding specificity for treated conditions, leaving several diagnosis codes out.
Accounts Receivable increased over an 18-month period, with no success in payment recoupment.
Lack of knowledge on the usage of the EMR and PMS utilized by the practice.
The office manager spent most of the day handling billing but was still unsuccessful in getting it in shape.
Increasing trend of denials, unbilled claims, and lack of completing notes on time resulted in a huge cash flow issue, with claims being held for 14 days before submission.
Clearinghouse rejections were not being worked.
Denial codes on the ERA were unclear, resulting in no appeal action.
Lack of process standardization in the practice.
Lack of integration between the front desk and billing.
Inability to collect payments.
Visit notes did not substantiate the level billed.
Solutions
Our Response
We began by focusing our action plan on bringing physicians back into coding compliance, addressing it as our primary concern. Weekly coding education sessions were implemented to help physicians identify and rectify documentation gaps relative to CPT codes billed.
LCD guidelines were communicated for all top treated conditions to enhance coding specificity and address co-morbidities.
A daily report was instituted to monitor scheduled visits against signed-off and billed claims, aiming for 0% unbilled claims within 24-48 hours.
We modified workflows to assist physicians in closing encounters promptly, enabling claims to be submitted within 24-48 hours post-encounter. This stabilization significantly normalized monthly charge submissions.
All previous denials were meticulously re-evaluated and appealed up to the third level where necessary, resulting in a 23% reduction in Accounts Receivable overall.
Denials were categorized and appealed accordingly, while reports were prepared for all clearinghouse rejections. Incorrect or invalid information was corrected and claims were resubmitted to align with payer records.
Weekly client education sessions were conducted to address potential billing and coding issues, ensuring timely note sign-offs and ongoing compliance.
Results
Practice Collection Rate Before Going Live with Billed Right
Collection Rate After 6 Months with Billed Right
Denials decreased By:
13
%
Improved accuracy and efficiency in billing processes.
A/R 0-30 Days Decreased By:
32
%
Faster collections and better cash flow management.
A/R 31-90 Days Decreased By:
57
%
Faster collections and better cash flow management.
Why Client Chose Billed Right
Solution-Oriented Approach:
We are in business to find solutions to your billing needs.
Holistic Growth Focus:
We help you grow and have your overall practice success in mind, not just your billing.
Dedicated Support:
Our team will start by dedicating an account manager to jumpstart your path to success.
Expert Analysis:
We analyze your practice financial reports and provide expertise on areas for improvement.
Industry Updates:
Helping you stay up to date with our industry's latest developments via our quarterly newsletters.
Strategic Partnership:
Billed Right is your strategic partner who will maximize your practice to its full potential.
Ongoing Commitment
We continue to work with this client to:
Provide workflow optimization.
Monitor claims for reimbursement lower than the contracted amount.
Improve claim denial management protocol.
Provide client education on billing & coding trends.
Conduct periodic practice performance evaluation meetings
Analyze and discuss financial reports on a weekly. monthly, and quarterly basis.
Let's Get In Touch
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