Case Study
Timely Filing Issue

Client Overview

The client is a multi-specialty healthcare practice providing services in family medicine, internal medicine, and various specialties. They were facing significant challenges with late claim submissions and a lack of follow-up, resulting in claims being denied due to timely filing issues.

Challenge

The primary challenge was that the practice was frequently submitting claims past the allowable filing deadlines, leading to a high volume of denials for timely filing. Additionally, there was insufficient follow-up on submitted claims, causing missed opportunities to address and correct issues before the claims were permanently denied. This situation created financial instability and increased administrative workload as the staff struggled to manage the backlog of denied claims.

Our Solution

Audit & Analysis

Conducted a comprehensive audit of the current claims submission and follow-up processes to identify bottlenecks and areas for improvement.

Process Optimization

Streamlined the claims submission process to ensure that claims were prepared and submitted well within the filing deadlines. This included setting up a standardized workflow and timeline for claim submissions.

Automated Reminders & Alerts:

Implemented an advanced billing software system with automated reminders and alerts to notify the billing team of approaching deadlines for claim submissions and follow-ups.

Dedicated Follow-Up Team

Established a dedicated follow-up team responsible for tracking the status of submitted claims, addressing any issues promptly, and ensuring that no claim was left unattended.

Solution Image

Results Achieved

Reduction in Timely Filing Denials

The number of claims denied for timely filing decreased by 90%, significantly improving the practice’s revenue cycle.

Improved Cash Flow

The practice experienced a 50% improvement in cash flow due to faster and more consistent reimbursements.

Enhanced Efficiency

The streamlined processes and automated systems reduced the administrative burden on the billing staff, allowing them to focus on more strategic tasks.

Higher Claim Approval Rate

The overall claim approval rate increased as a result of timely submissions and effective follow-up, leading to increased revenue and financial stability.

Successful Enrollment
0%
Recovery of Lost Revenue
0%
Improved Cash Flow
0%
Enhanced Financial Stability
0%
Conclusion
By addressing the root causes of late claim submissions and enhancing follow-up procedures, we were able to significantly reduce the number of denials for timely filing. Our comprehensive approach, which included process optimization, automation, and dedicated follow-up, not only resolved the immediate issues but also established a robust framework for ongoing efficiency and accuracy in claims management. This case demonstrates our ability to improve the financial health and operational efficiency of healthcare practices through targeted interventions and strategic support.
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