Medical Billing Case Study

Transforming Primary Care Management with Billed Right

This case study highlights a medical practice that partnered with Billed Right to tackle inefficient billing, lack of transparency, and staying current with industry trends. By leveraging Billed Right's expertise, the practice streamlined processes, improved efficiency, and focused more on patient care.

Practice Profile

Location: Orlando Florida

Specialty: Primary Care

Providers: 2

Locations: 1

Our Client

Background

This two-provider group delivers high-quality, personalized primary care.

They specialize in diagnosing and treating various conditions and offering preventive care services for both acute and chronic illnesses.

Turning to Billed Right

This client sought our expertise after their long-term Office Manager left.

Without any insight into their billing operations, they faced unpaid and denied claims, poor reconciliation processes, and workflow issues that resulted in decreased revenue.

Faced with these challenges, they chose to consult with Billed Right.

Challenges

Their Struggle

The following were the key pain areas the practice was grappling with:

• Lack of knowledge about billing.

• Unclear reports.

• Numerous unpaid claims.

• High number of denied claims.

• Many rejected claims at the clearinghouse level.

• Lack of reconciliation of charges.

• Inconsistent eligibility and benefits verification.

• High amount of patient accounts receivable (A/R).

• Under-utilization of the practice management system.

• Unfamiliarity with financial reports in their practice management system.

Solutions

Our Response

We initially took over and quality-checked their practice management system (PMS) for setup, activated unused modules, and created a new workflow for billing that integrates with front desk operations.

Our AR rescue team identified several reasons for non-payment, corrected them, and resubmitted the claims.

We set up scrubbing and edit screening codes to capture errors before claim submission.

Researched all balances, adjustments, and reversals to match the beginning balance in the account to the ending reconciliation detail, establishing daily and weekly reconciliation reviews.

Initiated routine eligibility and benefits follow-up with insurance carriers to ensure patient information is up-to-date and accurate before the time of the visit.

Segregated all clearinghouse rejections, standardized all error messages and rejection descriptions, and enhanced validation and claim edits to improve future clean claims.

Integrated a state-of-the-art patient statement design and process.

Enhanced their existing payment systems to improve patient satisfaction levels and payment collection rates.

Provided client education on additional uses of their practice management systems in areas such as scheduling, charge capture, billing procedures, and reports for improved efficiency and workflow.

Provided weekly coding education to physicians to improve documentation.

Results

Practice Collection Rate Before Going Live with Billed Right:

0%

Collection Rate After 6 Months with Billed Right:

0%

Charges Increased By:

0%

Less Focus on Billing Issues and more focus on patient volume and care.

Denials decreased By:

0%

Improved accuracy and efficiency in billing processes.

A/R 31-90 Days Decreased By:

0%

Faster collections and better cash flow management.

Why Client Chose Billed Right

Client needed a partner who knows their software well and can hit the ground running, understanding how each process works and enhancing it.

We helped bridge the gap in expertise and knowledge to maximize the practice to its full potential.

Offered full transparency so even the physicians are informed and not in the dark.

Continuously help them stay up to date with our industry's latest trends through our monthly reports, Quarterly Business Reviews (QBRs), and coding newsletters.

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.