Large-sized Ophthalmology practice reduced its denials from 29% to 8% in 6 months.

The Client:

Large-sized practice in Florida that deals with Retina.

The Challenges:

• 90+ AR was around 63%
• Claim denial percentage was 29%
• Liquidation of claim rate was 16%
• Manual payment posting was 25%

Plutus Health Plan

Highly experienced medical billers detected the issues hindering the client's revenue and systematically approached their ophthalmology billing needs.

Issues Detected

• Not leveraging its NextGen Billing Software to its full potential.
• Didn't have strategies to manage AR.
• Used error-prone manual payment posting methods.
• Lagged ability to negotiate successfully with Medicare.
• Unable to stay updated with state-specific Medicaid policies.  

After identifying the gaps in the billing process, Plutus Health's ophthalmology billing experts worked closely with the client to resolve billing errors.  

Plutus Health's certified coding professionals (AAPC, AHIMA) are trained in coding software such as EncoderPro, Flashcode, CodeLink, etc. We applied standard CPT, HCPCS procedure and supply codes, and ICD-CM diagnosis coding as per CMS guidelines to reduce coding errors.

Plutus Health Solutions

Plutus Health knows how to run each report from Nextgen – BBP, Unapplied, Collections, Charges, Payments, Adjustments, Cash reconciliation, Billed, Tasking, and Receivable Analysis. All these reports are created and run by Plutus Health with the help of memorized reports.

• Thoroughly analyzed and strategically worked to reduce AR.
• Did a trend analysis to find the most common reasons for denial and worked to minimize it.
• Improved the billing process to improve the liquidation of claims.  
• Completely eradicated manual payment posting to increase the average payment posting per month.
• Used automation to improve the overall RCM process and increased the GCR (Gross Collection Rate) significantly.

Results and Achievements

• Reduced 90+ AR from 63% to 27%.
• Claim denials went from 29% to 8%.
• Improvement in liquidation of claim rate from 16 to 27%.
• Increased ERA posting % and posted claims worth $12M per month.