Case Studies
Popular Use Cases
Medical Coding
(5.8K +)
Cardiology Case Study
Client: A large cardiology practice struggling with claim denials for complex cardiac procedures.
- Challenge: The practice was facing a high denial rate for procedures like cardiac catheterizations and echocardiograms due to coding errors and insufficient documentation.
- Solution: We implemented a tailored RCM solution focused on accurate coding (CPT and ICD-10) and pre-authorization workflows. Our team provided specialized training to ensure cardiologists and staff understood the importance of detailed documentation for these high-value procedures.
- Result: Denial rates dropped by 30%, and overall collections increased by 20% within six months.
Medical Billing
(5.8K +)
Oncology Case Study
Client: A multi-location oncology clinic experiencing slow reimbursements from payers.
- Challenge: The clinic’s complex chemotherapy billing, along with frequent coding errors, resulted in delayed payments and denials.
- Solution: We optimized their billing processes, ensuring accurate coding for drug administration, therapies, and supportive care. We also developed a system for monitoring claims and tracking prior authorizations to minimize delays.
- Result: Claims processing times were reduced by 40%, and their accounts receivable over 90 days decreased by 25%.
Transcription
(5.8K +)
Orthopedics Case Study
Client: An orthopedic group facing issues with high patient balances post-surgery.
- Challenge: Many patients were unaware of their out-of-pocket costs, leading to a high volume of unpaid bills after surgeries.
- Solution: We created a patient financial engagement plan that provided upfront cost estimates based on insurance benefits and out-of-pocket requirements. Our RCM team also implemented automated payment plans for patients.
- Result: The practice saw a 35% increase in patient collections and a 20% reduction in the time it took to receive payments from patients.
Medical Coding
(5.8K +)
Pediatrics Case Study
Client: A pediatric practice with a high rate of claim rejections due to coding inconsistencies.
- Challenge: The practice struggled with frequent rejections on well-child visits and immunizations, which affected their revenue stream.
- Solution: We worked with the pediatricians to ensure proper coding for preventive care and vaccinations, while also enhancing their billing software to identify errors before submission.
- Result: The claim rejection rate dropped by 45%, and the practice experienced a 15% increase in monthly revenue.
Medical Billing
(5.8K +)
Behavioral Health Case Study
Client: A behavioral health clinic dealing with denied mental health service claims.
- Challenge: The clinic faced constant challenges from payers regarding the medical necessity of services, which led to claim denials.
- Solution: Our team provided detailed training on the necessary documentation to establish medical necessity. We also revamped their claim appeals process and set up follow-up procedures for denied claims.
- Result: The clinic reduced their denial rate by 50% and increased collections by 18%.