Revenue Cycle Management of DME and HME

Client 

The client is a primary provider of PAP & Oxygen services in and around the Bay area. Although they are based in Thousand Oaks, California, but they provide services all over the country and is one of the largest Durable Medical Equipment, Prosthetics and Orthotics, and Supplies (DMEPOS) providers in USA.
 
Client Requirements

Our Client was looking for reliable & experienced professionals who could help them manage their end to end front office work that includes registering new patients, checking their eligibility & benefit information, qualifying documentation received, request authorization for services rendered, order entry, coding, billing, reaching out to patients for confirming the order that is received, doctor’s office follow up for any pending documentation, submission of claims in a timely manner, claims follow up for reimbursements (EDI & paper), payment posting (ERA & EOB), patient collections and denial management; overall the client demanded a vendor who could handle the end-to-end billing cycle on behalf of them that would be cost effective but worthwhile.

Despite considerable growth in patient services over the past decade, growth in revenue became a huge challenge for the client. Low productivity and inefficiency in processing of patient orders in a timely manner, loss of revenue for claims denial, delay in claims submission became quite evident; which eventually led to excessive increase in administrative and operating expenses. This is when the client decided to re-evaluate the way they had functioned so far and outsource the process instead, which they thought would be convenient as well as it will decrease the administrative expenses. 

The client believed that with this collaboration, they will start seeing considerable increase in production and revenue growth which is their only goal.
 
Problems 

Miraicure, with the help of its highly qualified and experienced staff, identified the challenges our Client was facing.
 
These include:
Delayed patient registration – led to patient dissatisfaction
Incorrect demographic entry – resulted in claim rejection
Insurance and eligibility verification not done diligently
Untimely claims follow up 
Coding & Billing errors that led to claims rejection
Pre-authorization not requested in a timely manner / prior to rendering the service.
Average AR days were at least 75 days 
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: 

Prepared a basic transition schedule without disrupting the client existing operations for a smoother transition.
Scheduled several sessions with the process owners to understand their existing process mechanism as well as to identify the areas that requires major attention.
Miraicure team also prepared a process manual based on our understanding of the processes as well as prepared a detailed transition plan which included training, setting up of IT infrastructure and implementation of a pilot batch who would begin the work and help curb the initial challenges of understanding and replicating the process while transitioning.
Miraicure team also shared various production and audit templates with the client to improve the quality and quantity of work based on the client’s requirement for approval.
After a steady but successful transition, Miraicure team went live as per process timeline and standard process guidelines & procedures.
First three months from the Go-Live date was extremely crucial as prioritization & distribution of tasks, real time audits, maintaining turned around time and meeting daily SLAs played an important role.
Daily review meetings were scheduled to ensure transparency of operation.
Much effort was put into reporting and sample reporting templates were shared with the client for approval.

Results 

The goal was to upgrade the billing process, by eliminating redundant tasks and by keeping track of the outcome at every step. Post process transition & steady operations, the client has achieved the following:

Increased productivity –
Accuracy of data – efficient work
Aggressive and timely follow up
Insurance coverage and authorization diligently checked and followed up on prior to rendering service
Proactive follow up with patient and physician’s office for any missing information / documentation
Daily tracking of calls to the patient who requires coaching
Timely correction of billing information related to initial order entry vs equipment that is delivered prior to the claim submission
Daily review of rejection report and analyze the rejection trend
Improvement in quality of work
Zero backlogs – significant improvement in payment cycle
Reduced denial rates
Improved cash flow
Reduction in denial rate

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