Medical Billing Case Study
Empowering Cardiology Excellence: Our Client's Success Story
Discover how our expert revenue cycle management solutions transformed a Cardiac & Vascular Group in Florida. Learn how we tackled challenges, streamlined operations, and achieved remarkable financial growth, allowing the practice to focus on delivering exceptional patient care.
Practice Profile
Our Client
Background
In 2015, we partnered with a four-provider practice specializing in cardiovascular treatments and interventional cardiology. At that time, they had a revenue generation of $1.7 million annually. Referred by another successful client, this cardiology group sought an experienced RCM partner to help grow their practice, expand cash flow, align their AR, and meet ambitious business expectations.
Uncovering Opportunities: Insights & Challenges
Billed Right conducted a comprehensive analysis of the entire revenue cycle, reviewing the practice workflow from scheduling (insurance benefit verification, prior authorization) to coding practices, claim generation and submission, payment posting, claim denial management, and patient financial billing.
Provider Group's Key Challenges
Challenge 1: Inadequate Process for Obtaining Prior Authorizations
Billed Right conducted a comprehensive analysis of the entire revenue cycle, reviewing the practice workflow from scheduling (insurance benefit verification, prior authorization) to coding practices, claim generation and submission, payment posting, claim denial management, and patient financial billing.
Our Strategy
We identified loopholes in the PA process and took ownership, following a systematic approach to check plan policies, establish lists of treatments requiring PA, and adhere to clinical guidelines for each payer. This relieved the client and allowed them to focus on patient care, improving PA-related revenue.
Challenge 2: Charging and Claim Submission Delays
Our diagnostic review found several issues with delayed claim submissions, leading to increased Days in AR and delayed revenue workflow.
Our Strategy
We aimed to submit claims within 24-72 hours from the date of service. By reviewing the internal practice process, we discovered notes were not signed timely. We educated providers, provided coding support, created an updated superbill, and prepared templates in the practice management system. This streamlined the workflow and ensured timely claim submission.
Challenge 3: Inefficient Coding
Inaccurate coding, particularly for peripheral interventions, was identified. This was impacting financial health, operational efficiency, and overall practice profitability.
Our Strategy
We reviewed the practice's coding workflow and provided feedback through our "clarifications" system. We educated the client on accurate coding for peripheral interventions, emphasizing "component" coding, appropriate billing for vessels, distinct interventional services, and imaging. We provided templates for effective procedural notes and highlighted the importance of accurate EHR/EMR data entry.
Every specialty has unique billing challenges, and cardiology is no exception. Issues included a lack of knowledge in coding changes and adapting to constant updates in cardiology procedures and technology. We addressed these by providing continuous education and support to ensure accurate and efficient billing practices.
Financial Performance
As a result of our strategic interventions, the practice experienced a notable improvement in financial performance year over year. The following table illustrates the charges billed and revenue from 2015 to 2021, showcasing consistent growth and stability.
| 2015 | $5,080,973.53 | $1,719,504.80 |
| 2016 | $11,364,413.46 | $4,467,5573.50 |
| 2017 | $12,857,209.33 | $5,323,459.75 |
| 2018 | $13,162,145.87 | $5,834,618.01 |
| 2019 | $13,162,145.87 | $6,076,790.62 |
| 2020 | $12,521,635.62 | $5,541,336.39 |
| 2021 | $14,897,814.02 | $6,516,349.48 |