Challenges
Solutions
Results
Prior authorization denials reduced to 1-2%, improving turnaround for patient scheduling, while freeing providers up to focus on patient care.
In 2018 and 2019, GLML, a growing lab in Farmington Hills, faced many billing challenges. One of their biggest issue they encountered was that their revenue cycle management (RCM) was not running smoothly, particularly with respect to their accounts receivable (AR). GLML was having a tough time keeping up with daily operations and growing its business. Here’s where things got tricky for them:
Their practice management system (PMS) was old and couldn’t keep up. Without sufficient automation, the staff was forced to do things manually, resulting in numerous mistakes.
GLML was burdened with a large volume of unpaid claims. A significant portion of their denied and rejected claims were older than 90 days. These delayed claims were hurting cash flow, making it harder for them to get paid for their work.
The team didn’t have enough experience in managing payer policies, dealing with denials, or handling complex appeals. This knowledge gap was leading to more mistakes, write-offs, and lost revenue.
As GLML grew, its billing system and staff couldn’t handle claims efficiently. They needed expert support to clear the backlog and establish a scalable billing process for sustained financial performance.
Seeing these challenges, GLML knew they needed help. They needed an expert partner who could handle their AR recovery quickly and set up a better system for the future. That’s when they decided to team up with MedCare MSO, a leading provider of medical billing services, practice management solutions, and RCM services.
When GLML partnered with MedCare MSO, they knew they were bringing in the right team. MedCare MSO had years of experience in helping healthcare practices fix billing problems and improve AR recovery. They got to work right away to help GLML:
MedCare MSO brought in robotic process automation (RPA) to update GLML’s PMS. This helped speed up the claims process, reduce errors, and get claims paid faster.
The team performed a detailed audit of GLML’s AR and found the biggest bottlenecks. By analyzing which claims were overdue the longest, they were able to prioritize the ones with the highest value and follow up more quickly.
Many claims were denied because of missing or incorrect information. MedCare MSO worked closely with GLML’s team to identify the root causes of denials, such as wrong CPT/ICD coding, and trained the staff on how to get it right. They also added real-time eligibility checks to make sure insurance was active before submitting claims.
Every two weeks, MedCare MSO and GLML held meetings to review KPI’s (key performance indicators). They tracked denial rates, AR days, and revenue trends to ensure everything was improving.
MedCare MSO provided regular financial reports showing how the AR was improving and where further adjustments were needed. They helped GLML stay on top of cash flow and make smart decisions about their finances.
Even though GLML has come a long way, there’s still more work to do. Together with MedCare MSO, they have set new goals for the future:
With MedCare MSO on board, GLML transformed its revenue cycle management. By automating billing tasks, improving AR recovery, and boosting revenue growth, GLML is now in a stronger financial position. And with AI and better data integration in the works, they’re ready to keep growing and providing top-notch services to their patients.
Ready to transform your practice’s revenue cycle management? Contact Medcare MSO today to learn how we can help you achieve similar results.
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