Business Transformation for Billing Entrepreneurs

Transcription

1 Business Transformation for Billing Entrepreneurs

2 About the Client Critical Issues Results Quick Facts About the Client A mid-sized Billing Company based out of Columbus, Ohio. They currently service multiple physician including OB/GYN Internal Medicine. They concentrate on medical practices in Clevel Cincinnati everywhere in-between, being a major hub for healthcare services. They had worked with two outsourcing partners before engaging with us. Critical Issues Results Sporadic Cash Flow Framework led Methodologies reduced waste by 45% Little to no bwidth to market the company s services Transparency in Reporting Client Retention High heads staff turn 30% 25% Improvement in First Pass Rate claims 35% Increase in Collections Increase in Profitability by 15% Quick Facts Collections 2 Mil Specialties OB/GYN, Internal Medicine, Anesthesia, Dermatology Employees 30 + Page 1

3 Problem Identification s Unique Solution Stardizing Stard Operating Procedures Problem Identification They had worked with two partners felt the lack of transparency. They did not have much of an idea if their partners were meeting their SLA s there were new FTE added to the team without an approval. This led to major communication break downs resulting in irate clients very high levels of stress in running the business things got worse with their partners. The owner herself was working on some key accounts as they were carrying huge backlogs due to key staff attrition. She was completely swamped had very little time for anything but work. The impact on the business was in terms of zero growth in a period of 18 months 2 lost clients. At some stage, they were considering selling the business, as they had almost given up on the business. s Unique Solution When met this client, the fatigue was clearly visible. Though very reluctant to try another partner, was engaged to support them with billing also some of their old AR. took a unique approach to turn this business around by leveraging some quick fix methodologies to start with but rapidly put in place holistic quality control programs. began with a consultative approach through earmm, our unique maturity framework, which has helped us deliver continuous measurable improvements in the billing industry. Stardizing Stard Operating Procedures As step 1, all existing operating procedures were pulled out. Many were updated about 12 months ago were incomplete in many aspects. The stard operating procedures were rebuilt based on current carrier client protocols the client was asked to review sign off. This gave a good start immediately reduced the day to day load on back forth clarifications coming in from the outsource team. Since took the billing there was 25% improvement in their First Time Right Claims which resulted in fewer denials improved cash flow. Page 2

4 AR Management Testimonials AR Management Now that billing was current closely monitored by quality control, the next focus area was on the AR practices. A separate team was deployed to tackle the old AR salvage what was possible. The books started looking cleaner as the process picked up pace. Denial Management was closely monitored to ensure that denials were acted on within 2 business days all accounts beyond 40 days were proactively chased. Accounts with online access were dealt with separately those that needed calling were given importance, due to the time it takes to resolve such accounts. We have significantly reduced accounts receivable resolution time from 70 days to 55 days for one of their larger clients. We took a deep dive into their denials analyzed the reasons on why claims were getting denied started delivering services through work-flow enablers which helped our AR team monitor, follow-up on resolve outsting accounts. During this process, our AR Cloud ensured 100% timely filing of denial appeals. The process is now further streamlined by auto creation of appeal letters re-billing, which has cut 75% of the transaction completion time reduced errors. Testimonials I would like to call as the turn around specialists. The domain understing expertise that they brought impressed me. They were so quick that in 3 days, I had clearly drawn out process flows SOP s created. They were able to offer a flexi staffing program which helped expedite closing out on the pile ups. - CEO Page 3

5 About EXDION comes comes with with years years of Property of Insurance Casualty Process Insurance Management expertise. expertise. Established services in the year clients 2000, ranging the company from Fortune employs 500 to 1800 small qualified medium insurance sized professionals. healthcare businesses. services clients is ISO ranging 9001 from certified Fortune for Quality 500 to small ISO medium sized HIPAA carriers certified for brokers. information security. is ISO 9001 certified for Quality ISO HIPPA certified for information security. The company thrives on Business Excellence leverages models such as Kaizen Six Sigma The company along with thrives technology on Business enablers, Excellence to continually leverages enhance models value such to customers. as Kaizen Six lays Sigma great along emphasis with technology on Accountability, enablers, to Integrity, continually Innovation, enhance value Transparency to customers. most importantly lays great emphasis Customer on Focus. Accountability, continually Integrity, Innovation, strives to Transparency deliver transformational most excellence importantly through Customer technology-centric Focus. process continually optimization strives to deliver continual transformational knowledge enhancement. excellence through technology-centric process optimization continual knowledge enhancement. is also closely associated with The Institutes 1 in 8 of its staff s today are solutions certified in include various Transformation US Insurance programs. Consulting, Business Process Management, Analytics Revenue Cycle Maturity frameworks that leverage CLOUD FIRST technologies. s solutions include Transformation Consulting, Business Process Management, Analytics Policy Lifecycle Maturity frameworks leveraging cloud first technologies. For more information visit us at or info@exdion.com Follow Us on All content / information present here is the exclusive property of Solutions Pvt. Ltd. (EXDION). The content / inform ation contained here is correct at the time of publishing. No material from here may here may violate copyright, trademark other applicable laws, could result in criminal or civil penalties. Copyright 2017 Solutions Pvt. Ltd. Page 4