Client Overview:
Our client is a multi-location urgent care center that faced significant billing challenges during the COVID-19 pandemic. With a high influx of claims and evolving healthcare regulations, their previous billing company struggled to keep up, leading to hundreds of denied claims due to timely filing issues and incorrect coding.
Challenge
The urgent care center encountered severe operational and financial challenges:
- Massive claim denials due to delayed submissions and coding errors
- High claim volume exacerbated by the pandemic
- Difficulty navigating evolving COVID-related billing guidelines
- Inefficient eligibility verification processes
These challenges led to disrupted cash flow and financial instability, requiring immediate intervention.
Solution
To address the crisis, we assembled a team of experienced billers and implemented a comprehensive strategy:
Expert Team Deployment:
Our team of seasoned billers, well-versed in urgent care billing and COVID-19 guidelines, took charge of the claims process. Their expertise ensured accurate coding and faster claim resolutions.
Data Analysis Using MGMA Benchmarks:
We began by investigating frequent denial patterns through MGMA benchmarking, identifying the root causes, and swiftly correcting errors. This enabled us to create a targeted action plan for claim recovery.
Proactive Denial Management:
Our billers focused on resubmitting denied claims with corrected information. Detailed appeals were crafted and submitted along with supporting documentation, significantly increasing approval rates.
Insurance Verification Specialists:
We deployed a dedicated team of insurance verification specialists who ensured accurate eligibility checks before claim submissions. This proactive measure reduced errors and improved claim acceptance rates.
Maximizing HRSA Fund Utilization:
Our team effectively leveraged HRSA funds for uninsured patients, ensuring timely reimbursement without administrative delays.
Results
Our strategic interventions yielded remarkable outcomes:
- Achieved a success rate of 97% or higher for paid claims
- Drastically reduced claim denials
- Streamlined the revenue cycle, ensuring a steady cash flow
