Facing challenges with high insurance and patient aged receivables along with total days in AR at 137, a remote cardiac monitoring company servicing over 1,000 clinics turned to SYNERGEN Health for revenue cycle management transformation.
Overview
Remote Cardiac Monitoring service provider based in California and Texas
Servicing over 1000 ordering clinics and providers
Over 5000 event monitoring cases per month
Over 6500 claims submitted / month
In-network and out of network payors
Internal central billing office
Monthly revenue at $3M
Implementation
Reconfigured billing system for optimized collections
Revised charge master
Re-engineering patient billing and collections process
Implemented DOCTRIX® Analytics and dashboards
Implemented weekly KPI monitoring and reporting
Converted payments and EOBs to electronic format
Optimized denials and appeals management
Implemented monthly root cause analysis and transformation
Help complete non-credentialed payors
Challenges
90+ Insurance AR > 71% and 90+ Patient AR > 84%
Days in AR >137 Days
First time payment rate < 55%
Revenue losses due to delays in securing patient consent letter
Revenue losses due to delay in securing medical records from referring providers
Out of network payors sending payments directly to patients
Results
50% increase in overall revenue
Days in AR reduced to 68 days
First time payment rate > 62%
154% increase in patient collections
Direct pay patient payment collections >80%
80% to 100% increase in large commercial payor payments
Over 98% of claims reviewed within 48 hours
Secured successful outcomes on major denials
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