SYNERGEN Health Increases average monthly collections of the Large Toxicology Laboratory in Texas by over 115% within the first three months

Delayed claim submissions, unorganized A/R follow ups, imprecise transaction posting and lack of visibility. Resultantly – below par collection rates, snowballing A/R and plummeting revenue. These are few of the complications that they were facing...

Overview

• Large Toxicology Lab based in Texas
• Servicing 250+ Ordering clinics & Providers
• Systems – LIS – Merge. PMS – AdvancedMD (AMD)
• Over 2,000 samples run / month
• Over 4,000 claims submitted / month
• 100% Out of Network Commercial payer billing
• Avg. Rev / Month - $1.5M

Implementation

• Implementation of AdvancedMD with DOCTRIX Integration
• Automated billing process with in-built claims scrubbing rules
• Custom claim follow-up by payer & submission method with appeals and denial management
• Revised fee schedule for optimum reimbursement
• SGH RCM Methodology & Best Practices
• 48 Hrs. TAT on billing
• Consistent Patient billing
• Standardized coding by payer guidelines
• Streamlining of the negotiation process
• Weekly KPI Monitoring, Reporting and Meeting
• Structured management of refunds & over payments
• Monthly AR walk forward and comprehensive reporting package
• DOCTRIX Dashboard for complete visibility

Challenges

• 90+ Insurance AR > 57%
• Days in AR of 150 Days
• >85% of claims billed after 15 Days of sample collection
• Irregular Coding practices & below-par fee schedule resulting in revenue loss
• Continuous decreasing trend in Collections
• Lack of comprehensive patient billing process
• Lack of proper process on Multiplan & network negotiations
• Lack of insight into RCM & Operations
• Unsatisfied Sales team & Referring Physicians

Results

• Avg. monthly collections increased from $1.5M - $2.3M
• 60% reduction in 90+ Insurance AR
• 25% increase in avg. payment per claim - increased from $1,040 to $1,300
• >98% of Claims entered & Submitted - 24 – 48 hours
• Minimum AR with risk of Timely Filing
• Compliant patient billing process
• Transparency & Visibility into KPI progress
• Data for Financial decision making
• Improved/compliant business processes
• Real-time dashboards and drill down to claim via DOCTRIX
• Improved satisfaction – Sales team & Referring physician
• Sustainable growth