The client was a Nephrology practice based in Texas. They have been providing specialized care to patients suffering from renal disorders since 2002. Unfortunately, their cash flow wasn’t in good shape, and the practice was in a severe cash crunch. The job was assigned to 314e’s team of highly experienced Revenue Cycle Management professionals.

Key Challenges

  • 2,973 charges were missing when 314e took over
  • Communication between payment posting and AR teams was completely broken, which resulted in poor handling of underpaid and denied claims
  • Unposted payments
  • 10% AR was lying unattended due to unposted payments and denials, and another 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 for various insurance portals & aggregators such as Payspan, ECHO, Zelis, etc., for receiving EOBs faster.
  • Creating strategies for write-offs and getting them approved by the customer to avoid case-by-case discussions
  • Quality audit of the old payment postings and fixing all inconsistencies found therein (increased revenue!)
  • Reviewing EDI reports fixing Payer and Clearing House rejections on old AR in order to improve revenue
  • Working on claims where the timely filing limit was not met and was written off for various incorrect reasons

Business Outcomes 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.