Texas Cardiology Clinic Increases Monthly Collections to $300K by Streamlining Patient Access and RCM Processes

The client is a well-regarded cardiology clinic with a number of locations in the Houston area, providing treatment for heart and vascular disease. They were looking for a revenue cycle partner to help increase reimbursements for their organization.

 

CHALLENGE

Missing Prior Auths and Major Collection Shortfall Threatened Financial Stability

Clinic leaders were experiencing lower than expected reimbursements and revenue recovery but were unsure of the cause. They also had challenges with prior authorizations, charge entry and A/R follow up.

 

SOLUTION

Infinx A/R Recovery & Denials Management Chosen to Help Identify Shortfalls

The cardiology clinic heard about our A/R Recovery & Denials Management (ARDM) platform and reached out. Once we learned what challenges they were facing, we agreed to help. Our specialists worked with their practice administrator, assistant manager and other team members to input their A/R data into our portal, which uses machine learning to analyze A/R data by procedures, payers, aging, location and more to identify collection shortfalls and untapped revenue.

 

Analytics Find Root Cause and Help Team Plan for Revenue Recovery

The Revenue Insights module of our ARDM platform revealed that the client was experiencing low reimbursements for intravenous and cardiovascular surgical procedures. The primary cause of the low reimbursements were denials due to the lack of prior authorizations. The solution also quantified the depressed A/R recovery as a collection shortfall of 19%, caused by a lack of charge entry and A/R follow up.

Based on these insights, our specialists suggested the clinic move forward with implementing AI-powered solutions to optimize their patient access, denial management and A/R recovery efforts.

 

Prior Authorization and Eligibility Implemented to Help Resolve Patient Access Issues

Our operations team implemented our AI-powered prior authorization and insurance eligibility solution to help resolve patient access related challenges while continuing to further investigate A/R leakages.

 

Prior Authorization Process Streamlined With AI and Automation

Our Patient Access Plus solution was able to verify the insurance eligibility of patients in real time when they arrived at their appointment. Artificial intelligence cross-referenced incoming patient information with its national database of payer rules to determine whether an authorization was needed and when necessary, submitted claims for authorization to insurance portals automatic. This step saved practice staff hours of payer phone and portal time.

Patient Access Plus also tracked prior authorization up until approval using automated status checks and alerting our team of specialists when necessary to handle exceptions. This human-assisted artificial intelligence approach allowed for 100% coverage of prior authorization cases, requiring practice staff to be involved only when needed to provide additional documentation or engage in a peer-to-peer review.

The Patient Access Plus dashboard displays patient information, insurance benefits, patient pay estimates, and status of prior authorization claims in near real time.

 

Improved Denial Handling Boosts Revenue Recovery

Our billing specialists used machine-learning-based insights to identify reimbursement bottlenecks, formulate and execute a plan for collecting the outstanding A/R and denial recovery. This allowed them to discover where revenue cycle process improvements needed to be made to prevent recurring problems.

ARDM breaks down A/R inventory into segments such as aging bucket, payer and denial code to help RCM teams prioritize claims. It also displays denial trends over time and helps detect anomalies and denial hotspots. It segments by denial code, procedure, facility and payer.

 

RESULTS

Reimbursement Rates Are Up and Monthly Collections Now at $300K

Within 3 months, the cardiology practice had a significant turnaround in key financial performance metrics, including a $59,000 monthly increase in collections.

• IMPROVED REIMBURSEMENT
  +21% (within 3 months)
• HIGHER MONTHLY COLLECTIONS
  +25% (within 6 months)
  Monthly collections increased $300K in 6 months
• REDUCED AGING A/R
  120+ A/R inventory reduced to $ 1.12M, 23.55% of the total outstanding A/R

Is your practice struggling with prior authorizations and experiencing depressed revenue recovery? Find how out you can increase monthly collections using Infinx’s RCM & Patient Access solutions here: www.infinx.com/schedule-a-demo.