Case Studies

Enhancing Billing and Accounts Receivable Services for an Orthopedic Specialty Provider in North Carolina


Founded in 2006 and based in North Carolina, our Client is a distinguished healthcare provider, operating with a substantial capacity of over 500 beds. They offer a comprehensive range of medical services with a specialized emphasis on orthopedic care. Their services encompass diagnosis, treatment, and rehabilitation for orthopedic conditions, catering to a diverse range of patients seeking advanced medical care.

The client aimed to implement a comprehensive medical billing solution that adheres to the regulated standards set forth by organizations such as the NUCC, CMS and HIPAA. Furthermore, the client sought to align their billing practices with the processing and policy requisites of various insurance firms.

In collaboration with a medical billing expert, the client aimed to address multifaceted challenges. These included timely generation of paper and electronic claims, innovative strategies for insurance plan participation, strict adherence to industry standards like CPT codes and HIPAA regulations, and seamless charge entry procedures for minimal discrepancies.

The Story of our Customer

  • Founded and headquartered in North Carolina, our client stands as a prominent healthcare provider with a notable presence.
  • The client's realm of expertise lies in offering specialized orthopedic treatments. Through a comprehensive range of services, they address diagnoses, treatments, and rehabilitative solutions, solidifying their position as a distinguished healthcare establishment within the region.
  • Seeking to enhance their operational efficiency and streamline their billing practices, the client aimed to establish an all-encompassing medical billing solution. This solution would not only align with the stringent standards set by entities such as the NUCC, CMS and HIPAA but also cater to the intricate processing and policy prerequisites of various insurance firms.
  • Teaming up with a medical billing expert, the client aimed to streamline claim generation, enhance insurance plan participation strategies, ensure standards compliance, and optimize charge entry procedures for improved healthcare operational efficiency.

The challenge faced by our Customer

The client was presented with a series of challenges that necessitated our assistance in devising comprehensive solutions. These challenges encompassed aspects such as ensuring precise and punctual charge entry, fostering private and government health insurance plan participation, and adhering to pertinent industry standards.

The task at hand encompassed the following key challenges:
  • Implementing accurate and timely procedures for charge entry, ensuring precision in financial transactions.
  • Formulating strategic approaches to elevate participation in private and government health insurance plans, employing techniques like co-payment and guarantee mechanisms.
  • Offering guidance to ensure strict alignment with critical standards, including standard procedure CPT and HIPAA regulations, fostering compliance and data security.

The Solution

In response to the client's needs, a comprehensive billing solution was developed to precisely meet their requirements. This solution encompassed a range of strategic measures to enhance patient service coordination, claims generation, quality assurance, and efficient financial management.

  • Enhanced Patient Service Coordination: Collaborated with medical professionals to accurately record patient service information and transmit it to payers.
  • Thorough Data Management: Maintained precise records of co-pay, facility, case, and accident details to ensure billing accuracy.
  • Consistent Claims Generation: Produced claims following NUCC standards, ensuring uniformity and adherence to guidelines.
  • Rigorous Quality Assurance: Formed a dedicated team to meticulously review bills, reducing errors and improving precision.
  • Accurate Billing Incorporating Minor Services: Applied modifiers to minor services alongside CPT codes for precise billing.
  • Efficient Electronic Processes: Enabled electronic claims transmission, patient statements, and records for streamlined communication.
  • Versatile Transaction Handling: Facilitated diverse transaction types including insurance payments, adjustments, denials, transfers, and write-offs.
  • Optimized Charge Capture: Implemented meticulous charge capture processes to enhance revenue management.

The Result

The solution yielded substantial outcomes for the client, enhancing billing efficiency and ensuring accurate and timely payments to healthcare providers. Additionally, it provided comprehensive insights into receivables, enabling proactive follow-ups and substantially reducing initial denial rates.

  • Optimized Billing Process: Streamlined the entire billing process, resulting in accurate and punctual payments to medical professionals.
  • Enhanced Receivables Management: Provided comprehensive insights into receivables, enabling proactive and effective follow-up actions.
  • Significant Denial Reduction: Achieved a remarkable 30% reduction in initial denial rates within the first three months of implementation.

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