Revenue Cycle Transformation increases revenue by 50% while reducing days in AR by half

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