Expanding on an already successful relationship, we collaborated with one of the largest national radiology groups to streamline their accounts receivables totaling over $111 million.
As a major player in the radiology sector, this publicly-traded company performs over eight million outpatient imaging procedures annually. With over 8,600 employees operating in 334 imaging centers in seven states, the organization has complex strategic partnerships with a number of different health systems, insurance payers, and accountable care organizations (ACOs). Managing these details requires finesse and a deep understanding of revenue cycle management.
They offer innovative, industry-first services focusing on quality patient care and state-of-the-art ancillary services. This includes a full suite of radiological services spanning from x-ray diagnostics to interventional radiology. Offering advanced modalities, top-tier technology, and same-day consults with leading sub-specialists in the country, rating at over 91% overall in physician satisfaction.
CHALLENGE
Unmanageable A/R Amid Growth and Industry Changes
As technology continues to evolve supporting impactful diagnostic and interventional services, reimbursements become more challenging. With changes in the healthcare industry and the growing impact of patient consumerism due to the expansion of High Deductible Health Plans (HDHP) and Health Savings Accounts (HSA), the organization faced increasing financial risk.
In the past, the organization’s regional business offices managed the revenue cycle management (RCM) process from insurance billing through claims denial processing to collections.As the business grew, so did the accounts receivable (A/R) until it had reached unmanageable proportions.
Billing on average $43 million per month, they saw:
- Net collections per month – $36M
- Denials per month – $6.2M
- Follow-up & denials net collections rate – 63.5%
- Average monthly write offs – $2.8M
- Aged A/R >120 Days – 32.9%
SOLUTION
Infinx A/R & Denials Management Chosen Based on Successful Partnership
Impressed by the results of our prior authorization solution, the organization engaged us to provide comprehensive RCM functions using our AI-assisted A/R Recovery & Denials Management (ARDM) solution. We planned to streamline their accounts receivables of over $111 million. Faced with shrinking margins and stakeholder demands for effective revenue cycle management, the group needed comprehensive solutions to protect their bottom line.
Our scalable, AI-driven ARDM platform and certified technicians seamlessly integrated into their RCM workflow. This integration brought several key benefits to the organization:
AI-Driven Prioritization Engine
Our proprietary, AI-driven prioritization engine used machine learning-based algorithms to evaluate each of their outstanding claims’ recovery potential and determine the best actions for follow-up and denials resolution.
Claims were corrected, updated, and submitted through EDI integrations to payer portals or clearing-houses for payment, ensuring efficient and accurate processing.
ARDM Software and Certified Technicians
Our ARDM software, combined with certified technicians, handled their complex claims and managed appeals through auto-generated letters and faxing. This approach also provided them with ongoing root-cause analyses, helping to identify and address operational improvements.
Smart A/R-Specific Workflow
By employing a smart A/R-specific workflow that seamlessly combined human and robotic processes, our solution helped the organization eliminate future backlogs and issues in patient access, coding, and billing functions.
Our algorithm continually learned and identified specific issues for targeted improvements, such as CPT mismatch, incorrect DOS, missing or incorrect insurance information, or benefits, ensuring a more efficient revenue cycle.
SOLUTION
Group Achieves 28% Increase in Collections + 64% Reduction in Write-Offs
During the initial year, the results were tabulated and evaluated. The organization successfully achieved the following:
AGED AR REIMBURSEMENTS
Additional reimbursements from aged A/R >120 days was 53.3%
DENIALS ADDRESSED
90% (within 5 Days)
INCREASE COLLECTIONS
+27.9% (within 12 Months)
IMPROVED AR
Year-over-year improvement of:
60+ A/R was 29.5%
120+ A/R was 58%
REDUCED WRITE-OFFS
-64% (within 12 Months)
MAXIMIZED A/R RECOVERY
A/R recovery was maximized through high dollar recovery identification only possible through the proprietary authorization determination engine
With the success demonstrated by ARDM, the organization initiated an ongoing engagement with us to handle their A/R process from beginning to end. Coupled with our prior authorization solution and post-service insurance discovery for uncollectible accounts, the organization has seen significant return to the bottom line for their investment.
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Have you used smart technology like AI, predictive analytics, and automation to improve your revenue recovery? See how a national radiology group’s cash flow improved using our A/R and Denials Management solution.
You can sign up here for a pdf of our case study to be sent to your inbox or continue reading below.