April 1st, 2019
$700,000 to $1 million
Revenue Increased by
Summary of our work
ARK Laboratory had outsourced their medical billing to a company that was not successfully managing claims. As a result, the lab was struggling financially, and it had become apparent that a complete overhaul of their revenue cycle management was needed. Medcare MSO was contracted to take over handling old AR and to implement a new system for managing claims and collecting payments. The billing company started on April 1st, 2019, and a little over three months later had increased monthly collections from $700,000 to about $1 million—a revenue increase of nearly 30% for the same amount of work being done by the lab.
Medcare MSO set out with three goals:
The state of the lab’s billing presented several challenges. Insurance portals had not been set up, making it difficult to find the status of existing claims and the software that had been in use was outdated and only limited information could be recovered, providing an incomplete record of claims and AR. Many phone calls to payers were required to determine claim statuses and reasons for denials.
Careful examination of unpaid claims found several errors commonly occurring:
- Auto insurance and worker’s comp claims submitted without the required injury/case date
- Non-covered diagnosis codes (not related to the accident/injury) being submitted as auto insurance and worker’s comp claims
- Claims submitted to the incorrect payer or with the wrong payer address or payer ID number
- Submissions with ineligible referring providers listed
- Incorrect or under-coding for polymerase chain reaction (PCR) and pharmacogenetics (PGX).
Medcare MSO’s team immediately set to work collecting old AR records and establishing the status of existing claims. It took about two weeks to collect the needed information and implement and launch the new billing software. The new billers also acquired insurance portals and modified the laboratory information software (LIS) to provide compliant access to patient personal information and test results.
Implementing Medcare MSO’s system identified and resolved the following issues:
Medcare MSO’s process includes analyzing charges and payments and generating reports that make the revenue flow clear to their clients. Analysis of ARK Lab’s billing and collections showed an increase in collections of nearly 30% over the first three months, bringing total monthly receipts from about $700,000 to approximately $1 million. Some of the specific accomplishments that brought about this result are:
- 10-15 day turnaround time for getting claims submitted and paid
- Up to 70% of claims paid without rejections or denials
- 50% decrease in old AR (Over the first two months)
- Clean claims resulting in up to 30% decrease in denials
- Effective AR management and reworking claims for up to a 30% increase in payments
- Achieved an all-time high reimbursement total of $1.1 million in the month of July 2019