Case Study
The Fix
Based on our assessment, CAPRN simultaneously started working with the front office operations and the backlog of claims.
Week 1
Two CAPRN staff reviewed all contracts and fee schedules, set up passwords for the front office staff and trained them in using the insurance websites to obtain eligibility and benefit information.
The billing process starts with the front office and so it was very important to stop these errors at the origination point. So, CAPRN also trained them on using new practice management software that would allow them to do their normal functions of scheduling, etc. and also would allow them to keep up with patient balances and provide a detailed view of their accounts. The other CAPRN staff started working on the backlog of claims and focused on those that could be resubmitted in the normal claims process without appeal.
Week 2
CAPRN began working with some of the doctors and educating them on the diagnosis and CPT codes that were compliant with their approved contracts and fee schedules. We also educated them on the authorizations required by certain insurance companies.
Weeks 3-4
We continued to work with the front office staff to establish policies and procedures for insurance companies and for any required authorizations. We also set up an end of day process to ensure that patients seen on the schedule were also billed for. We provided continuous feedback and generated reports to see the history of the claims and typical errors.
The Results
CAPRN's training of front office staff and process implementations resulted in the following improvements in the operations of the practice:
- Outstanding receivables reduced from $400K to $50K
- Revised office policies and procedures drastically reduced claims errors
- Cash flow for the doctors increased 35%
- Front office was functioning efficiently and continuously improving the claims process