A leading independent outpatient provider faced significant challenges in securing timely payments for their services. Rapid growth created an inefficient revenue cycle process, including verification, billing and inadequate follow-up procedures, resulting in a substantial backlog of unpaid invoices. This backlog threatened the outpatient provider’s financial stability and diverted critical resources away from patient care.
Customized approach
The client’s billing and collections teams were overwhelmed by a rising volume of claims, which resulted in low eligibility verification rates, high front-end rejections that delayed payments, billing backlogs, accounts receivable exceeding 52 days, and 28 percent of outstanding claims falling into the 120+ day A/R category. These issues ultimately reduced revenue per encounter and severely undermined profitability.
Access Healthcare implemented a suite of solutions to address the client’s challenges and transform its revenue cycle operations:
Eligibility verification and denial prevention:
Access Healthcare deployed specialized staff to perform thorough eligibility checks, reducing denials at the front end. Access Healthcare also reorganized billing teams based on specific skill sets and developed a comprehensive knowledge base for managing denial categories.
Denial management training:
Access Healthcare educated clinicians and RCM leaders on coding standards, payer-specific business rules, and insurance guidelines. Access Healthcare also created custom work instructions to address common denial causes and established a feedback loop to minimize avoidable front-end and clinical denials.
Enhanced claims follow-up:
Access Healthcare designed a structured workflow system to ensure timely follow-up on submitted claims and introduced immediate follow-up protocols for claims unresolved after 21 days.
Streamlined appeals processes:
Access Healthcare optimized appeal workflows within the client’s software environment and standardized tracking, reporting, and feedback mechanisms in accordance with industry best practices.
Operational efficiencies:
Lastly, Access Healthcare reduced the provider’s backlog by prioritizing critical claims, deploying specialized resources, and implemented standard operating procedures (SOPs) for effective denial and claims management.
To further develop a continuous improvement process, Access Healthcare helped the outpatient provider adopt the Six Sigma® DMAIC methodology.
The results
Access Healthcare’s solutions quickly delivered measurable and financially impactful outcomes:
Eligibility verification success rate: Increased from 80 percent to 95 percent.
Billing backlog: Reduced from over eight days to less than one day.
Days in accounts receivable (A/R): Reduced from 52 days to 30 days.
120+ day A/R claims: Lowered from 28 percent to 15 percent.
Revenue per encounter: Improved by 4 percent.
Monthly collections: Increased from $5.1 million to $5.4 million.
Through this transformation, the outpatient provider significantly improved its operational efficiency, which drove more financial stability. Additionally, these achievements strengthened the client’s partnership with Access Healthcare, enabling the provider to focus on delivering high-quality patient care while obtaining a healthier financial outlook.