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

Solution Approach

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

Business Outcomes

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.