Case Studies

The initial plan was to meet with each individual biller and collector including department heads to understand their process and their roles. Next, review past claims, coding and documentation to ensure claims were being entered correctly. This process entailed reviewing AR and trends and see what was causing claims to be rejected or denied. The final part was to review each insurance contract, rates, coverage restrictions and specific billing requirements. Several Outdated and expired contracts were identified for renewal. Systems were established to enhance accountability and minimize errors.

Working with each individual team member, efficiency measures were implemented, and goals set. Any issues limiting the staff from achieving their day-to-day goals were addressed. We trained the staff on the areas of weakness and helped in enhancing their strengths.

In reviewing past billing, we found deficiencies in coding, under coded services and completely missed coding for services provided. We implemented a new coding system and billed out test claims to verify our coding practices. We worked with the Physicians on documentation and detailing all services provided. This was very productive as it ensured all claims were well supported by documentation.

The insurance contract review process was also very beneficial. Insurance payments are based on agreed contract rates. These rates re – negotiated up and all providers were properly credentialed. This greatly increased the revenue stream that would have been otherwise lost.

Workers Compensation contracts are based on a State Workers compensation Fee schedule (that is) set by each state. This Fee schedule is also updated every year which requires close monitoring If the Billing Department does not update the new increased rates there is significant unnecessary revenue loss.

In this case we renegotiated all contracts, renewed any expired contracts and updated new fee schedule which instantly increased reimbursement.

CCOM grew to be one of the largest Occupational Medicine practices in Georgia. The Billing/Collection team was able to reduce the practice AR by almost 95%. The new EHR system was implemented which automated the billing process and reduced paper billing. Production targets and accountability systems were set. All these changes lead to a sustained, smooth operating, motivated and a most productive billing and collections department the company had experienced.