Case Study
Eligibilities Verification Issues

Client Overview

The client is a large healthcare provider offering various medical services, including family medicine, pediatrics, and specialty care. They were struggling with issues related to medical billing services, such as billing claims being sent to incorrect insurance companies, causing delays in reimbursements and increased administrative workload. Additionally, they faced Eligibilities Verification Issues, which further complicated the billing process and impacted their financial operations.

Challenge

The primary challenge was that claims were frequently being billed to the wrong insurance companies. This led to a high volume of denied claims, delays in receiving payments, and significant frustration for both the billing staff and patients. The misdirected claims created a backlog of work as the in-house billing team had to identify the correct insurance, rebill, and follow up on each claim.

Coding Denials

Blue-Cross-Blue-Shield

Decreased Revenue

Our Solution

Audit & Analysis

Conducted a thorough audit of the current billing procedures to identify where and why errors in insurance billing were occurring. This involved reviewing patient intake processes, insurance verification methods, and claim submission protocols.

Enhanced Verification Process

Introduced a more robust insurance verification process at the time of patient registration and before service delivery. This included double-checking insurance details and ensuring that the correct payer information was recorded.

Continuous Monitoring & Feedback

Established a continuous monitoring system to track the accuracy of insurance information and the success rate of claims. Regular feedback sessions were conducted to address any ongoing issues and make necessary adjustments.

Solution Image

Results Achieved

Reduction in Billing Errors

The rate of claims sent to incorrect insurance companies dropped by 85%, significantly reducing the number of denied claims.

Faster Reimbursement

The average time to receive payment from insurance companies decreased by 60%, improving the practice's cash flow.

Increased Efficiency

Administrative workload related to reworking claims was reduced, allowing staff to focus on other important tasks and improving overall productivity.

Enhanced Patient Satisfaction

With fewer billing errors and faster processing times, patient satisfaction improved as they experienced fewer issues related to their insurance and billing.

Reduction in Billing Errors
0%
Faster Reimbursement
0%
Increased Efficiency
0%
Enhanced Patient Satisfaction
0%

Conclusion

By implementing a robust medical billing verification process and leveraging advanced billing software, we were able to dramatically reduce the incidence of claims being billed to incorrect insurance companies. This led to faster reimbursements, decreased administrative burdens, and higher patient satisfaction. Our comprehensive approach not only resolved the immediate medical billing issues but also set the foundation for long-term accuracy and efficiency in the client’s revenue cycle management. This case demonstrates our capability to enhance medical billing processes and ensure financial stability for healthcare providers.

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