SYNERGEN Health

Privately held Orthopedic group in Nevada
Specialty: Orthopedic (Joint Replacement, Spine Care, Pain Management, Physical Therapy, Open MRI, Trauma Fracture Care, Upper Extremity Surgery, Sports Medicine, Etc.)
Over 50-years of history of providing the highest quality orthopedic services for patients throughout Nevada
Clients’ Revenue per year > $20M (2020)

Daily claims submission
Quarterly coding audits and constant auditing of coding by in-house CPC coders
Weekly discussions with front staff to review Prior Authorization Denials
Improved payment turnaround time through proper eligibility checks and escalation of un-insured patients prior to the appointment date
Fix denials within 48 hours
Follow up date based collection follow ups and daily follow up on denials
Aggressive follow up on claims passed 150 days from Date of Service
Real-time Analytics reports (DOCTRIX®)
Weekly progress reports
Monthly Revenue analysis report
Quarterly Onsite Strategy Discussions
Quarterly Discussions with Providers
Best Practices recommendations

An average of a 12-day delay in surgery claim submission
Non-specific coding and lack of documentation (Non-compliant coding related to E & M, Bundling issues)
Not Securing Prior Authorization for required services resulting in loss of revenue
Increased eligibility related denials
Increased denials related to Physical Therapy Cases
Lower first time payment rate
Higher zero pay CPT%
Poor transparency to overall and individual performance of providers

Billing turnaround time improved from 7 to 4 days
Seamless transition to new improved Practice Management System helping with the coding and documentation challenges
Reduction in the 90+ Insurance AR from 40% to 15%
Reduction in the Days in AR from 49 Days to 25 Days
Clean Claim rates improved to 99%
Consistently maintained Zero pay claims at less than 2%
Resolved claim % at 90 and 120 days is 99%
100% transparency into RCM processes
Best in class & compliant business processes