Introduction
The healthcare industry is constantly evolving, and medical practices, including urology clinics, are facing the challenges of optimizing revenue while maintaining high-quality patient care. In the following case study, we will be describing the scenarios faced by a mid-sized urology clinic located in New Jersey, USA, that was experiencing consistent revenue declines despite the steady influx of patients. Manual billing processes and coding errors have resulted in rejected claims, delayed refunds, and increases in operational costs. To address the issues faced by them, the clinic decided to partner with a leading end-to-end RCM company, like Globe Centrix, to manage their clinic revenue cycle.
We will now detail and describe the issues faced by the clinic, the solutions designed, and the process by which they were implemented seamlessly into the existing revenue cycle of the Urology clinic.
Challenges Faced by the Urology Clinic:
Inefficiencies in Billing: Charge entry is the key first step in any RCM cycle and the clinic relied on staff that wasn’t trained and a manager who was burdened with a plethora of administrative tasks This resulted in delays and errors, which slowed down the entire process.
Coding Complexity: Urology billing involves complex codes and regulations and requires an in-depth knowledge of the procedures and common practices. Not having the funds to deploy certified coders to key in correct charges contributed to a high rate of claim denials.
Revenue Leakage: The existing system failed to capture all the possible payments from the billable services, leading to revenue leakage. Not checking demographics and acquiring the necessary authorizations was one of the major causes of the ongoing losses.
Solution:
The urology clinic partnered with a specialized RCM company like Globe Centrix and our team of experts in urology billing and coding. We implemented the following solutions:
Automation of Billing Processes: A semi-automatic process was introduced where all the information about the services rendered was transferred to our team of charge entry specialists, who keyed it in accurately and well within the timely filling. Quality checks and our expertise helped streamline the process, reducing errors and speeding up the reimbursement cycle.
Specialized Urology Coders and A/R: Using staff in more affordable geographies gave the clinic enough funds to hire the necessary coders and implement an A/R team. Trained urology coders were used to ensure accurate code assignment and compliance. The skilled A/R team ensured timely payments and denial management, all of which resulted in an increase in revenue and profits and allowed the clinic to move towards further improvement strategically.
Implementation of Revenue Cycle Management (RCM) Tools: The increase in cash flow allowed the clinic to invest in additional RCM tools. An eligibility and present team were implemented, which further brought down the denial rate drastically, closing leaks and improving the overall financial performance.
Regular Audits and Quality Checks: Regular audits were introduced, and quality checks were performed consistently to maintain the required standard of the process. KPIs were continuously monitored, and improvement plans were introduced as necessary.
Implementation Process:
Assessment of Revenue Cycle: The first step was to comprehensively assess the clinic’s billing needs and identify weaknesses and opportunities for improvement.
Custom Solution: A tailored solution was designed, incorporating various RCM tools, keeping in mind the budget of the clinic and growth projections
Training and Integration: Off-site staff were trained on the new system, and the integration process was carefully managed to minimize disruption to daily operations. Necessary credentials were set up and the staff was made ready to start supporting the clinic, just as on-site staff were working remotely.
Continuous Support and Monitoring: We provided ongoing support, monitored the clinic’s revenue performance, and made adjustments as needed.
Results:
Increased Revenue: The urology clinic experienced a significant increase in revenue and a significant reduction in claim denials in the first six months after the partnership, and projections showed a consistent upward trend.
Improved Cash Flow: A streamlined billing process and faster reimbursement have improved the clinic’s cash flow and enabled better financial planning.
Enhanced Efficiency: Custom automated solutions reduced errors and freed up on-site staff to focus on patient care rather than administrative tasks, improving the overall efficiency of the clinic while improving the bottom line.
Conclusion:
Partnering with a specialized billing service provider proved to be a strategic move for the New Jersey Urology Clinic to address key challenges and optimize revenue streams. The successful implementation of automated processes, specialized coding, and continuous monitoring improved financial performance and operational efficiency.
Globe Centrix extends a strategic partnership beyond outsourcing; it becomes a collaborative effort to enhance the financial well-being of urology clinics. By entrusting billing services to Globe Centrix, urology clinics can unlock the full potential of their RCM systems, leading to increased revenue, improved cash flow, and enhanced operational efficiency. In a rapidly changing healthcare landscape, Globe Centrix stands as a reliable ally, empowering urology clinics to thrive and deliver quality patient care while maintaining financial sustainability.
Photo by Jan-Otto on Unsplash–Istock Image