End-to-End RCM–Migration–Large Out of State Physician Group Helps Providers Maximize Reimbursements

Large physician group helps providers maximize reimbursements on out-of-network bills, reduce the need to collect large balances from patients on bills, and eliminate the hassle of dealing with insurance companies.

Client: Large physician group helps providers maximize reimbursements on out-of-network bills, reduce the need to collect large balances from patients on bills, and eliminate the hassle of dealing with insurance companies.

Challenge

• Migrate (EPM) from CPSI to Kareo on all the tasks including charges, billings, rejections, payment postings, and denials management.
• Claims submissions, rejections, payments, denials and old AR liquidations.
• SLA enters charges within two business days, billing lag to be maintained.
• AR addressed at 45 days from aging.

The GeBBS Solution

• Implemented high-level status report to track charge review from new EPM and the rest of the tasks from the prior EPM.
• Reconciliation report was prepared to track charges and payments for CPSI and Kareo and both EPM’s.
• Payment reports were properly monitored as segregation of payment for OLD and New EPM.
• Dedicated team was assigned to denials, rejections, old AR claims.
• Created strategy for CPSI AR to wind-down AR project, shared reports with clients with global issues and controllable denials were fixed.
• Shared a dashboard which provided AR production – AR, charges, and payments.
• Provided client reports for 90+ AR, payment reconciliations, and denials within TAT.
• Initially, rejections were high due to missing taxonomy, the team researched and fixed.
• Medicare cost report identified ($5M) and escalated to the clientfor resolution.
• Global issue on Amerigroup offset cases ($3M) discovered and resolved.

Results

• Old AR saw a reduction from $78M to $35M in four months.
• Based on the performance of overall end-to-end process, the $60M client added two more clients.
• We collected around $4M from the old AR.
• We maintained the current task in Kareo and all SLAs were met.

New EPM denials worked within 5 days from the date of posting and AR was addressed from 45 days from the date of aging and claims worked on a 30-day cycle.