The problem:
A large specialty physician group started to notice their billing volume drop over a period of 6-12 months – but their office was busier than ever. They also noticed that their receivables had been dropping over a period of 12 months. This is a common problem, especially in medical offices with inexperienced staff who frequently do not know that they need to keep up to date with the most current billing guidelines, and sometimes don’t even know the billing guidelines at all. These problems occur with many outsourced billing companies as well, since they’re typically only interested in doing the bare minimum of work for their clients. This client in particular lost half a million dollars in just one year due to billing negligence.
The solution:
Physician Healthcare Solutions performed an audit of the client’s accounts and charts. We recovered and billed hundreds of thousands of missed charges and incorrectly coded or over-adjusted accounts. We also found thousands of dollars that were simply written off erroneously, when they could have been claimed by fighting the insurance carrier with an appeal and documentation. We discovered that the problem was that the client didn’t actually know how much they “should” be paid by each carrier. As a result of not knowing their contracted rates, the client was unaware that they were being under paid – and sometimes, not paid at all.
The results:
As a result of our efforts, PHS was able to recover over $200,000.00 of missed and lost revenues for this client. Had they come to us sooner, this client could have recovered more, but unfortunately many carriers will not allow you to go back further than 1 year to bill clean claims. In addition to this monetary recovery, PHS also trained the front office staff on proper techniques to implement when collecting outstanding patient balances and tracking and balancing daily processes, to ensure that, going forward, all charges and monies would be captured. We also educated the client’s physicians on medical documentation, electronic medical record systems, and other emerging methods that would allow them to utilize the full potential of their practice management system.
Since adopting Physician Healthcare Solutions as their billing solution, we have also renegotiated all of this client’s insurance contracts. Today, we can report that not only are they not losing money due to missed charges, incorrect coding, or erroneous adjustments, but they have also increased the amount they are now paid for services rendered by their contracted carriers!