How We Helped a Dallas-Based Rheumatology Practice to Recover
Explore our case study to see how we achieved a 30% revenue increase for a Dallas rheumatology practice by optimizing billing processes and reducing claim denials.
Medical Billing Case Study
| Practice | Rheumatology Specialty Office |
|---|---|
| Client | Dallas based Rheumatology specialty office |
| Client’s History | Experienced billing roadblocks that affected gross revenue and consumed several hours weekly |
| Key Challenges |
|
| Impact on Practice | Gross revenue loss and financial instability for practice |
The Case
A Dallas based mid-sized rheumatology practice underwent severe financial instability as it was grappling with persistent billing challenges, hampering revenue enhancement and diverting valuable time from patient care. This specialty practice handled complex autoimmune and musculoskeletal related disorders. A practice such as this, requires precise documentation for complex treatment and surgical interventions and specialized billing codes. With a strong network of clinical staff present at the facility and a steady flow of patients, the practice faced frequent coding errors, delayed reimbursements, and a labor-intensive billing workflow that strained staff resources.
Challenges
The nuanced nature of rheumatology care demands highly specific coding for services rendered. Staff often struggled to capture the correct codes, leading to frequent denials and a high rate of resubmissions. The time spent on rectifying these errors took away from precious time spent on other vital tasks and delayed reimbursement cycles.
Inefficient Workflow
Billing tasks were managed manually and were fragmented across different team members, creating an inefficient workflow. Staff had to juggle multiple systems and databases to manage patient information, check eligibility, and follow up on claims. This disorganized approach often led to miscommunications, further delays, and burnout among staff.
Revenue Leakage
Without a streamlined billing process, the practice was missing out on revenue opportunities. Errors and delays meant that some claims went unpaid or were denied indefinitely. The practice also lacked effective tracking of unpaid or underpaid claims, causing revenue leakage over time.
| Challenge | How we helped | Impact |
|---|---|---|
| Coding Errors | Integrated up to date coding protocol for accurate coded representation of treatment | Accurate coding at every step of treatment for complex cases |
| Outdated Workflow | Trained staff on recent billing regulations and correct use of modifiers | Improved administrative efficiency for filing claims timely and effectively |
| High Denial Rates | In depth auditing and regular claim followup | Improved reimbursement rates and reduced non payment |
| Inaccurate Documentation | Training staff on the features of updated version of their current EHR for a fully coordinated and optimized documentation protocol | Comprehensive documentation resulting in easier coding representation of treatment. |
Solution
Partnering with BillingFreedom, the practice revamped its entire billing process. BillingFreedom's comprehensive services provided the practice with specialized support that targeted the core issues affecting their revenue cycle. Key components of the services included:
- Automated Coding Assistance: With coding expertise tailored to Rheumatology, BillingFreedom's coding professionals significantly reduced coding errors. Our updated coding expertise helped the staff accurately code complex services, reducing the likelihood of denials and resubmissions.
- Empowering the Clinic Staff: The practice staff was guided on recent coding and billing guidelines and was taught to iterate complex coding mechanisms for certain treatment methods in order to boost reimbursements.
- Comprehensive Claim Tracking and Follow-up: BillingFreedom’s team provided robust tracking and follow-up mechanisms, ensuring all claims were thoroughly monitored from submission to payment. This prevented revenue leakage by minimizing unpaid or underpaid claims.
Results
Since implementing BillingFreedom’s solution, the rheumatology practice has seen remarkable improvements:
- Increased Revenue by 30%: By minimizing errors and optimizing claims follow-up, the practice experienced a 30% increase in revenue within the first six months.
- Reduced Claim Denial Rate by 25%: Accurate coding and centralized workflow management reduced the rate of claim denials and the need for resubmissions, speeding up the reimbursement cycle.
- Improved Staff Efficiency and Morale: Staff now spends significantly less time on manual billing tasks, allowing them to focus more on patient care and other administrative duties. This has not only improved workflow but also enhanced employee morale.
Conclusion
Through its partnership with BillingFreedom, the rheumatology practice was able to address its billing challenges head-on. By implementing an automated billing and coding protcol, the practice achieved a smoother workflow, reduced claim denials, and boosted revenue. BillingFreedom’s tailored approach empowered the practice to focus on delivering high-quality rheumatology care, knowing its billing operations were optimized for success.
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