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| Home » Healthcare Case Studies |
Healthcare Case Studies |
| Case Study - 2 |
Medical Billing Services |
| Industry : |
Healthcare |
| The Client : |
A large Hospitalist Practice in Texas |
| The Challenge: |
- Hospital medicine is a discipline concerned with the general medical care of hospitalized patients. Doctors, Physician Assistants or Nurse Practitioners whose primary professional focus is hospital medicine are called hospitalists.
- Hospitalists help manage patients throughout the continuum of hospital care, often seeing patients in the ER, admitting them to inpatient wards, following them as necessary into the critical care unit, and organizing post-acute care.
- Patient Tracking is difficult owing to large number of Physicians, Asst. Physicians, Nurses, PCP involved with individual patients, accompanied with Internal Hosp Transfers from different departments
- Patients arrive with little prior demographic information and require intense work to gather the proper information, authorize the patient's eligibility, bill and collect.
- Billing Conventions are more pertaining to different types of Insurance Coverage and different Insurance Contracts.
- High uncompensated care affecting the Collection Ratio
- Average AR (Insurance + Patient) days increased consistently
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| The Engagement: |
The current engagement is in the US Healthcare Provider Business, with InfiniteBPO providing Revenue Cycle Management Services. The process involves patient data entry, claim generation, submission to Insurances, collections, research & provider contract. |
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| The Solution: |
- InfiniteBPO has rich experience and high expertise in handling Hospitalists and ER Accounts involved in Hospital Billing.
- InfiniteBPO offered help to systemize the manual tracking of patient’s admission & discharge, making the process accurate and error free.
- Worked closely with the hospitalists & office staff to collect the information on Billing Conventions and compiled the Training Manual which helped both the practice and billing office to standardize the billing process.
- Persistently followed up with patients gathering complete and accurate information combined with eligibility verification & establishing Authorization with Insurance Companies prior submitting the claims for reimbursement.
- A dedicated team was deployed and continuously monitored on the follow up activities with Insurance Companies as well as Patients, on the previous denials.
- Separate team was established to resolve previous Authorization and Eligibility Issues.
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| The Results: |
- Astounding improvement in the Collection was noticed in present collections as well as the previous outstanding claims.
- Improved Billing System ensures and maintains the 99.99% accuracy in Patient and Insurance Data, resulting in clean claims.
- Substantial decrease in AR Days.
- Streamlined operations helped achieve turnaround times of 12-24 hours.
- Denial rates reduced to minimum and increased the collection ratio to maximum.
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Hospitalist Billing - Critical Issues (Click Here) |
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