Case Study (Medical Billing)
Medical Billing Service Provided to an Independent Practice
Preface
Rapid Care played an efficient role in streamlining the revenue cycle for a medical practice in San Francisco, California. We provided solutions that helped this independent practice (Internal Medicine) to resolve filing issues, enrolment issues, and ensuring proper payments. We helped them reduce their total AR considerably, so that their collections increased by 60%.
Background of the client
This independent practice at San Francisco specializes in internal medicine. They have their own clinic and lab along with nurse practitioner. Approximately 1500 patients visit here each month. Total bill amount per month is around USD 265,000 and the average collection amounts to roughly USD 135,000.
Challenges
This clinic was faced with several claim and payment-related issues. The following gives a brief summary of the payments outstanding:
- Claims denied due to non-submission of medical records: USD 85000
- Unpaid Medicare claims amounted to USD 74000
- Total BCBS claims that have not been paid amounted to USD 69000
Our Methodology
The strategy that we followed for resolving the issues of this independent practice is based on comprehensive process flow that is followed by different other activities till these issues are resolved finally.
Mode of Operation
We first identified the major payors – such as Medicare, Medicaid, UHC, BCBS, and others. The issues were resolved in order.
Incorrect billing and those not filed according to standard were resolved by changing the filing type.
When there was no update on change of address, we contacted the payors and arranged for change of address.
In cases of rejection due to not changing Medicare pre enrolment, our team got the rejection issue sorted with clearinghouses.
Payments not posted – caused by various reasons – were analyzed, information was retrieved.
Claims having multiple errors were reviewed with the coding personnel and the necessary changes were made.
Result
The practice became satisfied with our services and they have started working diligently toward their filing system improvement, error reduction, and streamlining of medical billing functions.
