Case Study on End to End RCM Process Management

Transcription

1 Case Study on End to End RCM Process Management

2 Implementing End-to-End RCM Solutions : A Case Study This case study elaborates on our capabilities, skill sets, and operational methodologies that have helped us in our successful implementation and continued delivery of services. Approach Client Took to Finalize the Right Partner To address challenges, client conducted a thorough search for selection of the right outsourcing/offshoring partner. They oated a very detailed RFP that asked companies to provide comprehensive information on their operations, skill sets, best practices, technological toolkits and above all expertise in handling the offshoreonshore relationship. After evaluating numerous companies, they shortlisted two and nally selected In nx as their preferred partner of choice. Factors that tilted the tide in favor of In nx Our demonstration of deep subject matter expertise across the entire RCM process Our clearly elucidated transition methodology Our ability to address their concerns as rst time outsourcing entity through their customized methodology Our strong technology toolkit including the TrackAssure product suite that enables strong business analytics and dashboards and reporting across processes Our infrastructure across the three delivery centers in India with strong business continuity, disaster recovery, technology and connectivity capabilities Our recruitment engine and training programs that enable fast hiring and easy scale up Customer Background Our client is a thriving therapy and surgical billing company handling end-to-end revenue cycle management (RCM) services for numerous physical therapy and surgery practices. The Challenges Growing at a robust pace, they were facing some critical challenges for maximizing their business performance. High staf ng cost hurting margins and pro tability in a n i n c r e a s i n g l y c o s t competitive environment Challenges with consistent productivity and quality across processes Dif culty in scaling up and exible ramp ups due to lack of availability of skilled and talented resources C h a l l e n g e s i n s t r o n g reporting and business analytics to client practices due to absence of strong technological tools

3 In nx Approach - Our Implementation Roadmap and Milestones Solution Project Factsheet Processes Managed Credit Balance We have transitioned the entire scope of RCM process from client's onshore team in Georgia to our offshore centers of delivery excellence in Mumbai and Hyderabad. Total FTEs Total Practices Managed Metrics of Transactions Handled Transition Milestones Week 2 Milestones 70 FTEs across all Functions 28 2, 00,000 CPTs/month Claims and Billing 000 electronic claims/month AR 7,69 claims with total outstanding AR of $2,88,269.2 Knowledge transfer on all processes process mapping, documentation, cross functional rapport System training and guidelines orientation. Cross functional transition team structure Live training and productivity benchmarking, implementation planning Infrastructure, technology and reporting dashboard setup and customization Bene ts & Results Claims and Billing: Claims getting billed 00% on a daily basis. Rejections worked and corrected within 2 hours : EOM closing for all clients done as per schedule. All batches worked and reconciled within the TAT of 2 8 hours Credit Balance: Refund details for all clients are now sent by th of every month : Successful client retention by ef cient identi cation of trends while working on denials and increased cash ow : Successfully managed to achieve the TAT of 72 hours ahead of schedule 2

4 Ramp up to full scale Phase - Go Live: Feb 0th 20 Function Billable FTEs (0 FTEs) Total Clients Refunds Total 0 Phase 2 - Go Live: March 0th 20 Function Billable FTEs (0 FTEs) Total Clients (Newly Added) Refunds Total Phase - Go Live: May 0th 20 Function Billable FTEs (0 FTEs) Total Clients (Newly Added) Refunds Total 2 8 0

5 Highlights and Problem Solving In nx has painstakingly developed methodologies to make the most of the opportunities and speedily overcome challenges. This was evident in our successful implementation of the end-to-end RCM solution for this client. Salient Best Practice Recommendations A. Original Process: Work les were generated by the client system (RT) after 28 days of claims billed. The AR follow up team was expected to work on these work les regularly on priority. Thus most of the claims addressed were either In Process or Paid Claims payments not yet posted categories which took substantial time to actually get resolved and completed. New Process: To change the priority of work les and address the claims based on their processing time and timely ling limit. For example, Medicare/BCBS was to be followed up after days and Workers compensation carriers to be followed up after 60 days. Result: This resulted in faster processing and accurate status tracking without pending work. B. Original Process: As per the old process there was no tracking of progress thus making it dif cult to track the non-compliance to TATs and missed appointments. New Process: In nx recommended running of the DCL report every hour, rather than keeping the TS- Scheduler open thus creating a conscious and well documented tracking process. Result: This resulted in improved compliance to turnaround time (TAT) and ensured meeting of all appointments. C. Original Process: As per the existing process, payment posters were assigned to individual clients/practices and they had to download the ERA batches by user. This resulted in multiple steps for each poster resulting in issues to achieve the desired productivity as they had to download batches, save them in client's drive and post both ERAs and EOBs. New Process: In nx recommended assignment of 2 different teams to work on ERA (posted electronically) and scanned EOBs (posted manually) and assign one separate admin to download all batches from Zirmed. Result: This increased the ef ciency and the batches are now completed well before time to close EOMs successfully.

6 Challenges During Transition A. a. Challenge: Instances of non-compliance to set TAT benchmarks. Solution Changed the strategy of allocating clients to individual users Assigned payer speci c specialists to address appointments faster Transitioning clients - days prior to Go-live date also helped to maintain the TAT benchmarks from the onset b. Challenge: Collaboration issues between Client and In nx teams during early stages of transition. Solution Focused efforts to conduct cross functional orientation and rapport building between the two teams Continuous reporting of performance, escalation of issues, and creation of collaboration/support culture to ensure con dence in the client team for In nx Strong onsite/offshore knowledge sharing sessions to ensure seamless transition of guidelines and nuances for ne tuning delivery to client satisfaction Our Toolkit for Continued Success Strong leadership and team structure with layered levels of accountability and responsibility Continuous process and productivity improvement programs for sustained performance Key talent retention and proactive recruitment and training for attrition management and scale ups Continuous technology enablement initiatives to empower processes Proactive account management and partnership approach for sustained customer delight

7 California, USA Mumbai, India Chennai, India Hyderabad, India 0 Stevens Creek Blvd., Suite 27,San Jose, CA 99 P: + (08) F:+(08) 0 08 Unit No., SDF-, SEEPZ SEZ Andheri (East). Mumbai India P: +9 (22) F:+9 (22) Plot No. B27, Phase II, Z o n e B, M E P Z S E Z, Sanatorium, Tambaram, Chennai. India P: +9 () F:+9 () Level -, Tower- 2, SEZ IT Park,(Raheja's Mind space - South), Hardware Park, Srisailam Highway, Maheswaram- Mandal, Dist. - Ranga Reddy. Hyderabad Phone: Disclaimer This case study is the copyright of In nx Service 20. All information presented in this document is a result of the research; analysis conducted by the authors of In nx and represents their interpretation from various aspects. This case study cannot be published by a third party for commercial uses and is for educational purpose only.