Case Study Insurance Verification

The Client:

Our client is a well established radiology imaging center started in the year 2003. Growing in increase number patient scheduled appointment and ‘walk in’ patient for imaging service with fewer frontend staffs to handle patient service. Some of their services include:

• Open MRI
• Multislice CT
• PET/CT Fusion Imaging
• Ultrasound (3D & 4D)
• Diagnostic X-Ray
• Dexa Bone Densitometry etc..,

Challenge Analysis:

BOSS was approached to support their frontend staff by providing ‘virtual assistance’. The customer’s accounts receivables was getting older and after their year-end audit they find most of the claims denied for patient coverage and lack of prior-authorization. An awkward situation arose and their employees find cumbersome to make patient verification because most of them were ‘walk-in’ patients; on an average client had 65 percent of ‘walk in’ patient for scanning and x-rays. The client finally approached BOSS in April 2004 when all their in-house efforts failed to raise their A/R in a cost effective manner. The customer faced problems like:

• Disordered patient appointments
• Too many ‘walk In patients’
• Less staffs to handle patient, appointment scheduling and verifying patient eligibility and coverage benefits
• Increase in denials due to improper on no verification done on patient coverage and benefits
• No prior authorization obtained before performing imaging service.
• Our client was out of network with few payers
• Spending more time in verification instead of taking care of patients
• Patient volume has come down because of torrent patient bills

Billing system: Misys Tiger

The following was their denial structure before Boss was contracted.

The Solution:

• The customer signed up just 6 month contract for on ‘virtual assistance’, verifying patient’s eligibility and benefit. After the contract period client gained confidence and trust on BOSS ‘virtual assistance’ potential over making better revenue from insurance company.
• A dedicated ‘virtual assistance’ team were deputed to handle the account
• The specialized team consisted with full time employees worked as a auxiliary force with client front office staffs for patient verification and benefits.
• BOSS developed documents and manuals for complete and easy verification process.
• BOSS developed verification process to make sure that verification is done prior to scheduled appointment with lead time of 24 hours.
• All ‘Walk In’ patients’ verification is done with lead time of 1hour prior to appointment.
• Swift Authorizations and Referrals from insurance companies has been obtained in order to increase number of patients
• Issues with insurance companies were addressed and resolved fast.

Results:

The Quick Solution:

• witness that the average AR days were brought down from 34 to 23 days within 6 months
• witness that the number patient increased from 400 to 600 per month
• experience significant decrease in denied claims percentage as a result of increase in collection ratios
• concentrate on patient care and see more patients, with the availability of more time, and a clutter-free office
• enable employees to focus on core business aspects, instead of verifying benefits over the phone with insurance companies
• increase operating efficiency and reduce administrative costs
• witness that the percentage of patient bills came down as a result of maintaining a friendly relationship with patients
• BOSS virtual assistance created ample time for our client’s frontend staffs to focus on patient service, have good rapport with patient which lead to healthy revenue channel.

The following statistics will show how Boss made tremendous improvements in increasing patients and made cash flow consistent for the customer.


These numbers show that:

• the percentage of denial have come down significantly and the outstanding A/R decreased from 65% to less than 20% in a period of 6 months
• the number of patients have increased tremendously from 350 to 600 every month The customer takes home more money now even after paying Boss fee for services.

The customer has started a franchise system and they have selected Boss for all the same functions at their franchise offices.

About Boss Healthcare:

BOSS is an Offshore Medical Billing Company based in Chennai, India providing medical billing services to physician practices, hospitals, practice management groups and third party medical billing companies of all sizes and specialties across US. Our services include, Insurance Verification, Patient Answering, Medical Coding, Demographic Entry, Claims Entry, Submission of Claim, Payment Posting, Denial Management, Accounts Receivables service and Revenue Cycle Management.

“We always spell sUccess with U”

Want outsource your Insurance Verification, Patient Answering, Medical Coding, Demographic Entry, Claims Entry, Submission of Claim, Payment Posting, Denial Management, Accounts Receivables service and Revenue Cycle Management.