Reduce Claim Rejection Rates for a Leading Family Practice

The Client

The client is a well-established family practice in Houston, TX, specializing in Geriatric medicine

challanges

Problem:

The practice’s claim rejection rate was going up at an alarming pace. The malaise lay in their internal process, but despite their best efforts the client failed to manage it. To stop the slide, the client decided to partner with us. They wanted us to identify and plug the loophole, as well as streamline the entire process to make it more efficient.

solutions

Challenge :

Our preliminary evaluation of client’s existing system revealed three major flaws:

  • Inaccurate data mapping between two front-line client software
  • Inappropriate follow-up, and resubmission of rejected claims.
  • Incomplete or un-verified patient information

So the challenge before us was to remove mapping inaccuracies and make submissions error-free.

results

Solution

Drawing on our experiences from the past, we knew for an effective solution we needed to cleanse the data first. So, our team first evaluated the data for quality, accuracy and usability. This helped us identify and eliminate data that was responsible for inaccurate results. Next, we worked upon developing a new way to avoid data mapping errors. The new approach was based on well-developed use cases for each map. We then tested the validity and reproducibility of the map followed by creation and implementation of a maintenance program to make it flexible to updates and changes.

To handle rejections, we introduced an easy-to-use reporting system which could deal with denials both qualitatively and quantitatively. We ensured that the system synced with the established workflow to insulate billing process efficiency. Lastly, we trained the front desk staff on how to collect and verify all the required information.

Benefits

Our solution helped the client in the following ways:

  • Identify causes of rejections and underpayments
  • Reduce need for resubmissions
  • Avoid needless claims delays
  • Realize maximum claims
  • Map patient data accurately
  • Improve front-desk staff accuracy
  • Improved and seamless workflow

If claims rejection is affecting your business revenues, contact us now for an effective solution.


Get a Quick Quote

We respect your privacy Read Our Policy

Hippa & RBMA logo