Transforming Revenue Cycle Management: How a Medium-Sized Healthcare Facility Boosted Monthly Collections by 40% and Cut Claim Rejections in Half

Claim Rejections and Denials - The facility continues to face challenges with a staggering high rate of 32% claim denials and rejections, resulting in significant revenue loss. Pinpointing and addressing the root causes of these denials remains an obstacle, necessitating a deeper investigation into their billing processes.

Rejections present a significant threat to medical practices' financial health, leading to substantial revenue loss. Our analysis led to actions that improved the rate at which claims were accepted on the first attempt. Through initiatives like improved coding accuracy and staff education on payer policies, we streamlined rejections, reducing the rate from 32% to 15% within the first 3 months of our partnership. Additionally, without denial management processes, providers may face a 10% to 15% revenue decrease. We conducted data analysis to identify denial patterns and root causes, optimizing processes. Our CRCS- certified associates collaborated closely with facility revenue cycle teams to streamline denial management processes, ensuring expertise in revenue cycle management. This led to a noteworthy improvement in cash flow, increasing monthly collections from $3 M to $4.2 M within the first few months of our partnership.

Outdated Billing Software - Their reliance on outdated billing software has led to inefficiencies, hindering their operations. The lack of automation worsens this issue, resulting in frequent manual errors in coding and billing processes reducing their First Pass Ratio to 70%. While not purely a software issue, the interface and design of billing software can contribute to human error during data entry.

Implementation of Advanced Billing Software - With nearly two decades of experience, our team at AMI has collaborated with numerous firms across a variety of platforms. Through proactive coordination among intra- vertical teams, including coding, charge entry, and eligibility verification, we established a comprehensive approach from the outset which led to a significant improvement in the First Pass ratio from 70% to 90%.

Ineffective Communication - Inadequate communication between billing and clinical teams leads to incomplete or inaccurate billing data. Furthermore, the absence of a streamlined procedure for capturing and documenting chargeable services intensifies this issue which resulted in less than 35 claims being processed in a day.

Training and Collaboration - Training sessions were conducted for billing, and AR teams to improve communication and ensure precise documentation of chargeable services. The team was regularly informed about the ongoing updates in ICD code regulations to facilitate the process. A collaborative approach was adopted to bridge the gap between the intra-vertical teams of the partner with AMI along with the partner’s on-shore team. Partners team at AMI Team had a detailed analysis of the inventory and they executed the workflow implementation plan while leveraging various automation tools to optimize and prioritize the claims. This strategic approach eliminated redundant tasks like manual data entry, duplicate data verification, repetitive claim status checks, this manual appointment scheduling, and redundant documentation review, enhancing efficiency and enabling manpower reallocation to other essential functions, effectively leveraging technology. These initiatives resulted in a notable increase in staff productivity, rising from 35 to 60 claims per day.