Case Studies

Enhancing Claim Acceptance Rates for a Prominent Family Practice in Houston, TX

Overview

Founded in 2006 and based in Houston, TX, our client is a reputable family practice centering on Geriatric medicine. Their expertise lies in offering tailored healthcare solutions for the elderly, effectively addressing their distinct medical requirements.

The client offers comprehensive medical services in Geriatric medicine, catering to the health and well-being of older individuals aged 65 and above. Their services include diagnosing, managing, and preventing medical conditions commonly associated with aging, thereby enhancing the quality of life for their elderly patients.

Med Billing Expert addressed client challenges by evaluating their system, rectifying data flaws, and introducing an effective reporting system for claim denials. The solution enhanced workflow efficiency and trained front desk staff for accurate information handling.

The Story of our Customer

  • Founded in 2006 and based in Houston, TX, our client is a reputable family practice centering on Geriatric medicine. Their expertise lies in offering tailored healthcare solutions for the elderly, effectively addressing their distinct medical requirements.
  • The client offers comprehensive medical services in Geriatric medicine, catering to the health and well-being of older individuals aged 65 and above. Their services include diagnosing, managing, and preventing medical conditions commonly associated with aging, thereby enhancing the quality of life for their elderly patients.
  • Med Billing Expert addressed client challenges by evaluating their system, rectifying data flaws, and introducing an effective reporting system for claim denials. The solution enhanced workflow efficiency and trained front desk staff for accurate information handling.

The challenge faced by our Customer

The client grappled with significant challenges within their operational processes that impeded their efficiency and revenue stream. These challenges resulted in elevated rates of claim rejections, delayed reimbursements, and potential financial setbacks for the client's family practice.

Upon our initial assessment of the client's current system, we identified significant issues:

  • Inaccurate data mapping between front-line client software.
  • Inadequate follow-up and resubmission of rejected claims.
  • Presence of incomplete or unverified patient information.

Our objective was to rectify mapping inaccuracies and ensure error-free claim submissions.

The Solution

The client faced a growing claim rejection rate due to data mapping issues, improper claim follow-up, and incomplete patient information. These issues led to financial setbacks and operational inefficiencies.

    Data Quality Enhancement:
  • Evaluated data for accuracy and usability.
  • Eliminated inaccurate data to enhance quality.
    Improved Data Mapping:
  • Developed a precise approach to prevent mapping errors.
  • Tested and implemented a reliable map with use cases.
  • Created a flexible maintenance program for updates.
    Efficient Rejection Management:
  • Introduced a user-friendly reporting system for denials.
  • Integrated design with workflow for efficiency.
  • Trained staff in accurate information collection.

The Result

Our solution delivered the following benefits to the client:

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

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