Mid-sized Orthopaedic practice collected ~$350K every month through AR

The Client

Mid-sized Orthopaedic practice in KY.

Challenges Faced

• Reduction in financial flow
• Abrupt halt in payments
• Significant increases in outstanding AR
• The rejection percentage was very high.
• Coding was inappropriate

Plutus Health Plan

Plutus Health's team started this project to bring in better collections to gain the client's confidence. Our billing experts thoroughly analyzed the current RCM process and detected the issues that needed immediate attention.

Issues Detected

• Claims got rejected due to Inconsistent data, Taxonomy & NPI, and Payor ID issues.
• Inappropriate coding led to claim denials.
• Claim denials happened due to eligibility.
• Medicaid balances did move to patients.

To manage AR, Plutus Health's experts compared pre-change revenue numbers vs. post-change revenue figures. We did a comprehensive analysis through the billing and operations team and a series of QA/QC checks and measures.

The audit's depth and thoroughness enable a comprehensive analysis of the revenue cycle prior to the switch that can be compared directly to the revenue generated in the first 30 days, creating the benchmark for comparison to the former revenue total numbers.

Plutus Health Solutions

Plutus Health is an expert in Nextgen billing software. We know 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 our Orthopaedic billing experts with the help of memorized reports.

• Checked the TFL with all commercial payers and categorized workable and non-workable accounts.
• Classified workable accounts into two categories: High-dollar and Low-dollar.
• Crossed TFL for non-workable accounts that cannot get liquidated. Shared a separate report with the client and made them understand the reasons for being non-collectible.
• Shared what could get liquidated from workable accounts to the client and proved it in 6 months.
• Reviewed patient credit balance to ensure the credit amount in the patient is correct.
• Moved pure patient-related denials to patients. Posted insurance denials and flipped the balance to patients.
• Detected coding issues and gave suggestions on coding. Medical coders also mentioned the slowing of revenue due to coding denials.
• Found other major denials from eligibility and used raw claims data before transmission to detect denial trends.
• Used automation to check eligibility. Claims with incorrect eligibility were reported to the client and were corrected.

Results and achievements

Plutus Health fulfilled all the promised outcomes successfully. This accomplishment led to client satisfaction and entrusting us with the management of other facilities, involving payment posting, handling rejections, and managing accounts receivable (AR).

Key achievements include:

• Implemented strategic measures resulting in the reduction of rejections from 17% to a mere 9% within a span of 2 months.
• Significantly lowered denials from 30% to 14% in just two months.
• Realized an impressive 11% increase in revenue efficiency.
• Achieved an approximate total of $4 million in collections solely through AR efforts focused on insurance.
• Maintaining an average monthly collection of approximately $350,000 through AR endeavors.
• Enhanced time efficiency by a notable 9%.