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.
- 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.
- 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.