Physician Billing

Client:

The Client is a medical practice with many doctors working for them. It is a NY based medical practice, which provides a wide variety of medical services to its patients. 
 
Client Requirements:

Our Client was looking for experienced professionals who could help them with their medical billing problems. They wanted to reduce the overall AR time-frame and generate revenue more consistently without any delays caused due to silly errors. 
 Problems:

Miraicure, with the help of its highly qualified and experienced staff, identified the challenges our Client was facing. 
These include:

  1. Follow-up on claims was not on time. 
  2. Claims got rejected due to Coding & Billing errors.
  3. Valid authorization not taken from the concerned authorities before providing the service.
  4. Insurance and eligibility verification not done diligently
  5. Average AR days were at least 75 days 
  6. Collections percentage was a mere 40 %

Solution provided by Miraicure:

The problems that the Client was facing were complex, but nothing we haven’t seen before. We diligently analyzed the root causes and formulated appropriate steps to overcome them. 
These are: 

  1. Our team performed eligibility and insurance verification diligently before submitting the claims. We also got in touch with the members to obtain accurate and up-to-date insurance information. It helped our Client to submit clean claims and reduce the turnaround time efficiently.
  2. Claims are thoroughly checked for minor mistakes and were submitted within 48hrs of receiving patient demographics.
  3. Follow-up on rejected claims within 24hrs.  
  4. We followed a robust prior authorization process to obtain valid authorizations from the insurance for future claims before the service and on outstanding claims where ever possible. 

Results:

  1. The rate of Clean Claims which were submitted increased significantly to 95 %.
  2. Proper insurance verification increased Patients collections (Copay, Coinsurance, and Deductible) from 40 % to 75 %. 
  3. Our robust follow-up on claims and our ability to handle denials with ease helped bring down the AR days to a mere 30 days. 
  4. The Client’s revenue increased significantly, increasing profit by at least 20 %.  
  5. We successfully helped the Client to maintain a regular cash flow.
  6. Patient experience improved as the Client was now able to focus all its attention on delivering high-quality patient care without worrying about its revenue. 
     

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