Spectrum Medical

This case study explores how Coronis Health partnered with Spectrum Medical Partners, a complex hospitalist group, to significantly improve their revenue and reduce claim rejections.

Spectrum Medical Partners faced several challenges with their billing process:

Complex Billing: Handling acute and post-acute care billing with multiple insurance carriers.

Contracting Issues: Difficulties with existing contracts impacting reimbursement.

Coding Issues: Inaccurate coding leading to claim denials.

Practice Management System (PMS) and Electronic Health Record (EHR) System Challenges: Incompatible systems hindering data flow and billing efficiency.

Backlogged AR: Previous attempts at RCM failed to address these problems, creating a large backlog of uncollected revenue.

Coronis Health took a multi-pronged approach:

Rapid Response: Within 72 hours, Coronis dispatched a team to assess the problem’s scope.

Expert Team: A multidisciplinary team of experts in implementation, client services, analysis, systems, and account management was assembled.

Thorough Analysis: After reviewing the situation, Coronis recommended a new PMS and clearinghouse to streamline operations, recognizing the potential short-term risks.

System Migration: Spectrum transitioned to the new PMS, improving data flow and billing efficiency.

Contract and Coding Review: Coronis collaborated with Spectrum to correct coding errors and renegotiate contracts for better reimbursement.

AR Cleanup: Coronis launched a targeted campaign to recover lost revenue from Spectrum’s backlog of unpaid claims.

Collaborative Meetings: A three-day meeting enabled both teams to address challenges, align on goals, and strengthen their partnership.

Continuous Improvement: Coronis established routines for ongoing process refinement, data mapping, and client feedback to ensure continued success.

Coronis Health’s multi-pronged approach yielded remarkable outcomes for Spectrum Medical Partners:

Revenue Doubled: Spectrum saw a 100% increase in net revenue within 8 months.

$1.25M for Skin Grafts: Coronis helped capture an additional $1.25 million specifically from skin graft billing in 2023.

Fewer Claim Rejections: Improved coding and payer mapping significantly reduced claim denials.

Recovered Lost Revenue: AR cleanup efforts helped Spectrum recover a substantial portion of lost revenue from previously backlogged claims.