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A case study on unbilled encounters and how an urgent care centre solved it
Discover how Medientsky Billing revitalized a Florida urgent care center, resolving 800 unbilled encounters and coding denials, with advanced RCM tools and support.
Table of Contents
Introduction
Running an urgent care practice in today’s volatile healthcare market is tough business. With cost containment, compliance and financial pressures breathing down the necks of medical practices, it is an everyday challenge to survive. Glen Ortiz, the administrator of an urgent care practice, was looking for medical billing help when he chanced upon Medientsky Billing. Glen Ortiz, is an ER physician who along with two of his peers runs an urgent care practice in Florida. The practice had three ER physicians and 3 nurse prac- titioners on board. Their monthly charges were 1 million dollars. They collected $320,000 a month. They had a payer mix of 65% Florida Blue, 20% commercial payers and 20% Medicare and used the eClinicalWorks EHR.The urgent care practice charged 3 times of Medi- care and had a regular patient flow. They were working with a coding company based in Texas who charged fee per claim.
The Challenge
“I’m desperately looking for someone to handle our billing volume as we are struggling with close to 800 unbilled patient encounters”, he said. “We are also looking to expand our practice and have decided to start a new prac- tice later this year. 3 E.R physicians will be hired to manage the new location”, he added. But the dwindling collections of the practice threw cold water on the urgent care practice’s plans.
The Major Revenue Cycle Issues Faced by the Urgent Care Practice
- Mounting unbilled patient encounters
- Insufficient medical documentation
- Underperforming payment contracts
- Understaffed billing department
The Solution
Medientsky Billing believes that the first step to strengthening a revenue cycle is to first identify where the faultlines are. To help medical practices analyse their revenue cycle gaps Medientsky Billing launched the highly successful LRRA (Lost Revenue Recovery Audit). Our LRRA team conducted a thorough audit on the urgent care practice’s revenue cycle and found several major issues.
Key Findings of Our LRRA Audit
- The urgent care practice was frequently underpaid by Florida Blue.
- Most of the procedures were incorrectly coded. External injury code was repeat- edly coded as a primary code .
- The doctors did not lock encounters at the end of the day.
- The patient statements of the practice were not handled efficiently.
Medientsky Billing in action
The audit findings convinced Glen to let Medientsky Billing handle the entire revenue cycle operations of his practice. Prior to working with us Glen had outsourced the medical coding and patient billing processes to different companies. He was happy with the gap findings and met us the following week to create a sustainable revenue growth model for his practice. He wanted us to give him a doable GCR (Gross Collec- tion Rate), which our team promptly did.
He also wanted our revenue auditing experts to conduct:
- E&M LEVEL AUDIT
- 100% ADJUSTMENTS
- REJECTION RATIO AND DENIAL ANALYSIS
Our revenue auditors conducted an audit of top 200 denied claims above 60 days to identify the top 10 denied claims that need to be flagged and dealt with immediately. After the second audit Medientsky Billing was all set to roll. Medientsky Billing’s regional director of Florida visited the urgent care facility to brief them about our go-forward plan.
The Transition
The transitionperiod is a phase where most medical practices need unwavering support. It usually results in loss of revenue and productivity. This is the phase where miscommunication and missed financial details usually occur! Medientsky Billing has, to avoid bottlenecks, developed a full-fledged transition plan to handhold practices through this tricky phase. Our AAPC/AHIMA credentialed coding experts worked closely with the facility to heave it out of its coding slump. They enabled the practice to develop a meticulous plan to improve the coding efficiency of the practice. As the AR backlog was high and most of them nearing the dangerous 180 days mark, we assigned 4 AR callers to fol- low-up and resolve pending AR. Our regional manager visited the urgent care facility twice a month to oversee opera- tions and facilitate a hiccup-free transition.
The eCW billing experts!
We are an everyday user of the eClinicalWorks EHR. There were no steep learning curves when the practice signed up with us. We also have a technical support team for eCW users to resolve and troubleshoot issues. Glen was more than happy to work with us as he was his in-house billing team just couldn’t get a hang of the EHR.
Negotiating Better Contracts…
Medientsky Billing has a team of contract negotiation experts who work with insur- ance companies closely to negotiate stronger contracts that improve yield. Our state-of-the-art contract management software enables our team to analyse the roots of payment variances right down to the service line level.
We found out that the contract performance of the urgent care practice was sub-opti- mal. There was a clear variance between payments and contracted rates. After several rounds of phone calls and frequent meetings we finally resolved the underpayment issue and helped the practice wrangle out a contract that increased reimbursement.
Medical Documentation Oversights:
After analysing the clinical documentation of the practice we noted that the practice did not lock encounters properly. Our CDI experts explained to the physicians about the importance of locking encounters and how it contributes towards better clinical documentation.
We also recommended several clinical documentation best practices such as:
- Conducting periodic clinical documentation reviews
- Keep CDI consistent across the practice
- Monitor CDI productivity at regular intervals
Whittling Down On Unbilled Patient Encounters:
The medical practice was snowed under with a huge number of unbilled patient encounters. Our 24/7 workflow and urgent care billing specialists worked full tilt to bill and receive reimbursement for the 800+ unbilled patient encounters that the medical practice was struggling with.
Results
A Sharp Reduction in Operational Costs:
The urgent care practice had tied up with a debt collection agency to handle patent billing. They were paying a huge fee and wanted to save on costs. Medientsky Billing offered to manage the patient billing tasks of the practice. We also put in place a more streamlined process to handle patient statements. With our cost-effective medical billing and revenue cycle management services we brought down the operational expenses of the medical practice by 30%.
No Monthly Minimums, No Integration Headaches, No Fuss:
Yes, we are easy to work with. The urgent care practice saw a collection swing of about 20% between summer and winter. This made it difficult for them to work with a company that wanted a guaranteed monthly minimum. With Medientsky Billing there is no such fuss! There are no start-up charges or monthly minimum headaches. We have also developed several medical billing and revenue cycle KPI tracking appli- cations built specifically for urgent care practices.After a brief demo of theBillingBridge, our RCM KPI tracking app that offers actionable insights, visually beautiful dashboards and realtime KPI tracking capabilities, Glen was impressed, and our team added another happy user for our full-featured revenue cycle app! theBillingBridge is integrated with several major EHRs and is the only RCM app that an urgent care practice would ever need.
Conclusion
The urgent care facility wanted to find out whether they were over utilizing cer- tain CPT codes. Glen asked if we could scrub their codes and run spot checks to ensure accuracy and increase the efficiency of their coding cycle. We assured him that our coding managers and subject matter experts provide in-line, realtime coding audits to spot coding deficiencies before it snowballs into a huge issue. We also introduced Glen to our coding app that automates and streamlines the coding cycle of healthcare organizations. CodePro monitors the productivity of the coding process, tracks cycle times, runs audits to ensure codes are in compliance with NCCI initiatives and analyses the top paying CPTs of practices. Users can also track coding workflows in realtime.
Growing together!
We believe in growing together with our clients. After the revenue cycle issues of the urgent care practice were resolved and the collections looked up, they wanted to expand their practice and hire more doctors. Glen wanted to start a practice near an ER hospital to generate patient population. Through our network we helped Glen scout for a location and start another urgent care practice that would financially flourish with Medientsky Billing’s expertise.
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Highlights
- Mounting unbilled patient Encounters resolved.
- Improved coding efficiency and reduced AR backlog.
- Achieved 30% reduction in operational costs.
Client Specs
- Location: Washington
- Specialty: Behavioral Health
- EHR: Incredible
- Average collections: 300K per month
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