Large Sized Ophthalmology Practice Collected $140K from Old AR within 3 Months

The Client:

The client is 49-year-old Ophthalmology Practice in the US

Challenges Faced

• High appointment cancellations
• No dedicated patient access team
• AR buckets were rising
• Very large and growing 90+ AR
• Sluggish cashflow

Plutus Health's Plan of Action

• We assessed the current state of their RCM and measured their current Key Performance Indicators (KPIs), which helped to illuminate the problems in the client's RCM processes.
• Our experts measured current KPIs against our "Best Practices KPIs" to know the gap in performance of each KPI related to RCM.
• Our AR specialist detected the root causes of the out-of-control AR and provided a solution to minimize it.
• We worked on all the issues to deliver positive results.

Issues Detected

• Lack of RCM Leadership expertise and Staffing/FTE allocations were not in line with the workload required by each key RCM team (EV, Auth's, ERA posting, Patient Payment Posting, Billing, Collections, and AR)
• Front desk was overloaded with too many tasks. They were unable to collect and confirm data, including outstanding high patient balances, before offering services to the patients
• Client did not have a staff member or process in place to track and manage correspondence received from insurance companies
• There were appointment scheduling problems and patient demographic errors
• Client faced long delays in posting both insurance and patient payments
• There was a long charge lag which led to revenue loss
• Client had missing encounters that affected their overall RCM process

Plutus Health Solution

• We recommended new team alignment with FTE allocations
• We standardized the SOPs for each key RCM function
• We recommended measurement tools and management processes
• We identified critical KPIs to watch for and measure with daily, weekly, and monthly reporting
• We measured the performance of each KPI related to RCM

Results

• RCM performance, Revenue losses, and AR results started coming in around the 45-to-60-day mark
• Patient and employee satisfaction increased
• Correspondence was being tracked and managed 
• Reduced timely filling limit write off
• The posting got stabilized, and the turnaround time reached 48 hours 
• AR got worked on priority

Achievements

• Brought down average AR days below 50
• Collected $140K from old AR in 3 months
• Successfully completed the RCM consultancy project
• There have been a lot of improvements across all RCM functions