Delayed claim submissions, unorganized A/R follow ups, imprecise transaction posting and lack of visibility. Resultantly – below par collection rates, snowballing A/R and plummeting revenue. These are few of the complications that they were facing…
Case Studies
SYNERGEN Health Increases average monthly collections of the Large Toxicology Laboratory in Texas by over 115% within the first three months
Overview
- Large Toxicology Lab based in Texas
- Servicing 250+ Ordering clinics & Providers
- Systems – LIS – Merge. PMS – AdvancedMD (AMD)
- Over 2,000 samples run / month
- Over 4,000 claims submitted / month
- 100% Out of Network Commercial payer billing
- Avg. Rev / Month – $1.5M
Implementation
- Implementation of AdvancedMD with DOCTRIX Integration
- Automated billing process with in-built claims scrubbing rules
- Custom claim follow-up by payer & submission method with appeals and denial management
- Revised fee schedule for optimum reimbursement
- SGH RCM Methodology & Best Practices
- 48 Hrs. TAT on billing
- Consistent Patient billing
- Standardized coding by payer guidelines
- Streamlining of the negotiation process
- Weekly KPI Monitoring, Reporting and Meeting
- Structured management of refunds & over payments
- Monthly AR walk forward and comprehensive reporting package
- DOCTRIX Dashboard for complete visibility
Challenges
- 90+ Insurance AR > 57%
- Days in AR of 150 Days
- >85% of claims billed after 15 Days of sample collection
- Irregular Coding practices & below-par fee schedule resulting in revenue loss
- Continuous decreasing trend in Collections
- Lack of comprehensive patient billing process
- Lack of proper process on Multiplan & network negotiations
- Lack of insight into RCM & Operations
- Unsatisfied Sales team & Referring Physicians
Results
- Avg. monthly collections increased from $1.5M – $2.3M
- 60% reduction in 90+ Insurance AR
- 25% increase in avg. payment per claim – increased from $1,040 to $1,300
- >98% of Claims entered & Submitted – 24 – 48 hours
- Minimum AR with risk of Timely Filing
- Compliant patient billing process
- Transparency & Visibility into KPI progress
- Data for Financial decision making
- Improved/compliant business processes
- Real-time dashboards and drill down to claim via DOCTRIX
- Improved satisfaction – Sales team & Referring physician
- Sustainable growth
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