Establishing an Efficient Revenue Cycle Management (RCM) Workflow to Move Claims and Minimize Errors & Delays

A Nephrology practice based in Texas that provides specialized care to patients suffering from renal disorders since 2002.

Key Challenges

The 314e team had to come up with a solution to overcome the following challenges:

Cash flow wasn’t in good shape, with 2,973 charges missing
Communication between payment posting and AR teams was completely broken, which resulted in poor handling of underpaid and denied claims
10% of AR was lying unattended due to unposted payments and denials
10% of the total AR was adjusted off without any processing information

314e lent precision to the overall process of RCM by:

Posting all pending payments, denials, and adjustments via ERA/EFT
Enrolling in various insurance portals & aggregators such as Payspan, ECHO, Zelis, etc., to receive EOBs faster
Creating strategies for write-offs and getting them approved by the customer to avoid case-by-case discussions
Auditing the old payment postings and fixing all inconsistencies found therein to increase revenue
Reviewing EDI reports, fixing payer and clearing house rejections on old AR to improve revenue
Working on claims where the timely filing limit was not met and was written off for various incorrect reasons

Achieved all of the following within the first 70 days:

Reduced AR from $1,551,358 to $680,842
Increased payments from $85K to $270K per month
Decreased AR Days from 185 to 63 314e was able to bring out evident changes and improvements to the client’s Revenue Cycle Management (RCM) workflow, using its expertise in audit, process improvement, and working the AR.