BIS Revenue Reclaimed: 21% Cash Growth
Operational Excellence in Revenue Cycle: Fewer Denials, Stronger Collections
FOCUS AREAS TO COMPLETE CHALLENGE
Prevention Measures
Coding Review and Denial Analysis
Insurance AR Team Progress
CHALLENGE SUMMARY
Reduce denial rates to below 8% and improve overall revenue collections.
RESULTS SUMMARY
Denial rates reduced from 15% in 2023 to consistently below 8% between April and October 2024. Payments increased by 21%, leading to significant revenue growth.
Revenue cycle management (RCM) plays a pivotal role in ensuring financial success in healthcare operations. Business Integrity Services (BIS) took on the challenge of addressing high denial rates and improving collections for key focus locations. The task demanded a comprehensive approach to verification, authorization, coding, and denial analysis, with an emphasis on consistency and efficiency.
BIS deployed a data-driven approach to understand denial patterns and payment trends:
1. Verification:
Ensured all appointments were thoroughly verified before the service.
2. Referrals for Clinic Visits:
Handled the complete referral process, including PCP identification, request submission, and follow-ups.
3. Authorization for Procedures:
Reviewed payer guidelines to meet medical necessity requirements and coordinated amendments for non-compliant records.
4. Coding Review:
Conducted in-depth reviews of medical records, ensured correct diagnosis codes, and applied appropriate modifiers.
5. Denial Trending:
Added two certified coders to track denial trends, analyze root causes, and implement preventive measures.
6. Insurance AR Team:
Deployed two full-time employees (FTEs) dedicated to reviewing AR from 2023 and 2024 to maximize collections.
