The COVID pandemic created challenges for practices that had to pivot their operations to restore revenues, adapt to the changing environment, and accelerate growth.

This webinar, brought medical billing experts from Coronis Health together to discuss best practices for improved financials and provide case studies on how practices have improved operations. In this second part of a 3-part series, we share specific information and case studies highlighting coding and technology. 

Coding

Coding plays a pivotal role in your practice’s financial success, but barriers to obtaining reimbursement in healthcare are significant. Payers consistently change their rules, making it more difficult to get reimbursed for services rendered. Coronis provides insight into your coding and uses data analytics to spot trends, understand what you’re billing for, and show you how to generate more revenue. 

In addition to reviewing current coding practices, Coronis also understands national coding changes and how those changes directly and indirectly impact your business, as well as affect your revenue moving forward, allowing you to make proactive business decisions. 

Coding Case Studies

In addition to changes in coding practices, we also see changes in payer contracts that impact coding. This requires a careful analysis of the services being rendered, their corresponding codes, and the reimbursement process.

An FQHC who came to work with us had a significant shift in their payer mix. They had a growing number of patients moving away from traditional Medicare towards Medicare Advantage. At the same time, these Medicare Advantage payers were insisting this health center sign new contracts that included new services they may not have provided previously. Providers must document and code the complexity of the visit to capture all available incentive revenue. 

We advised this client to record their complexity, capture those available dollars, and maximize incentives. We then revised their workflow to review AWW/IPPE documentation against provider selected codes and payer requirements:

• Added services documented but not coded
• Suggested template/EHR edits to maximize automation of quality measures
• Provided specifics and pointed feedback to providers
• Offered real-time rejection and denial feedback 

Results:

• Increase of collection rate on AWW/IPPE services
• FQHC captures additional incentive dollars and ensures contract compliance

Our second coding case study consists of one of our clinical independent laboratory clients that vastly grew their lab revenue by adding COVID PCR testing during the pandemic. While the additional revenue stream was a bonus during a very difficult time, this also created a challenge for the client since the foundation of their business model shifted to performing and billing for COVID testing with very limited test panels for toxicology, pathology, and genetic testing. Once the inevitable need for COVID testing would die down due to the implementation of COVID vaccinations, this raised the undeniable question of how this lab could sustain profitability and grow their business post-pandemic.

In the summer of 2020, we understood that the COVID testing volume would not be at the current magnitude it was, reviewed the client’s current payer mix, and projected the timeline of when COVID testing would take a downturn. Therefore, to sustain profitability and growth, we would need to add additional clinical laboratory services to this client’s test menu. 

To do so, we helped this client create panels for toxicology, chemical pathology, and genetic testing. We did this by having weekly meetings with their lab director and director of operations to discuss and analyze their current equipment. We discussed whether there may be a need for additional equipment and the costs, versus the average reimbursement rates per the payer mix within the current market. 

We also reviewed their laboratory software systems and their capabilities to add additional testing, while updating the interface with our billing software to accept the additional codes for a streamlined approach. We reviewed and helped update their current requisition forms, provided education on clinical policies from papers nationwide, and coding guidance to obtain optimal revenue. 

Results:

• The client grew three times their pre-pandemic model to post-pandemic success

Technology

Many facilities still rely on outdated systems. Ninety percent of healthcare organizations still send paper statements and make inconsistent outbound cash calls to patients. Despite the money spent on postage and staff resources, only 22% of patients make payments.

Visibility of the Revenue Cycle Case Study

Demographic and socioeconomic factors lead to successful collection of patient balances. However, by utilizing technology, we can begin to even out the playing field by reaching out to patients digitally and building specific patient notification rules.

In this case study, we had a client who moved from a 30/60/90 paper statement cycle to an e-notification heavy billing cycle. 

Results:

• In the first week of going live with the software, we collected 62% of the average monthly patient revenue
• Client saw a 200% growth rate since the technology was introduced
• The client’s patient revenue has steadily increased at a growth rate of 18%

The most critical part of managing any revenue cycle is understanding your current state and where you want to go. One FQHC came to us with their days in AR steadily increasing, their write-offs also increasing, and losing claims to bad debt. Their critical claims were being ignored, left untouched until they hit a point where they were no longer collectible. 

Coronis Health’s BI tool provides an aggregate high-level view of the entire AR. This affords visibility into issues, trends, and performance – BEFORE exceeding filing limits. In addition, Coronis’ BI tool proactively pinpoints priority claims, allowing the client to focus on the claims that needed to be worked on.

Results:

• A 7% increase in the average payment collected per visit
• An 8% drop in the claim denials rate, signaling a major improvement in operational efficiency
• A decrease of over 50% in the volume of paper EOBs

What our client found most valuable with the BI tool was our ability to provide high-level dashboards that provide visibility into the workflow, as well as the revenue cycle.

Are you losing revenue due to coding errors or outdated systems? Let us help you bring your practice to the next level and boost your revenue cycle. Contact us today to learn more.