Practice: Urgent Care center that provides occupational services, worker’s compensation and primary care services
Patient Volume: 37k per year
Revenues: $4.4m per annum
Billing /Posting Delays: 4-days
Insurance Follow-up: 50-60 days after claim submission with some claims never initiated for follow-up action
Current Billing Solution: Outsourced Billing
Situation: The center provides onsite X-rays, laboratory, splinting and casting, physicals for DOT, immigration and sports, as well as travel meds and laceration repair. They were using an EMR and practice management system, but it wasn’t providing them the support that they needed. The outsourced billing company the practice utilized wasn’t familiar with the needs of an Urgent Care Center, and was building up an ongoing backlog of billing so the charges were not being submitted in a timely fashion. In addition, some of the applicable codes were not billed based on Urgent Care billing guidelines due to lack of industry specific expertise which ultimately translated to lower overall reimbursements. A/R was as far out as 80 days, and the percentage of patient account receivables going to a collection agency was high meaning reduced revenue for the location.
HealthQuist’s client management team was able to quickly and efficiently review all existing protocols and contracts, ensuring that they were properly set up for charge entry and to capture the accurate billing codes to insurance. A dedicated audit team was launched to review each medical record to check the accuracy of the coding, and ensure that all applicable codes were billed. Any charts that were not completed by the physicians were escalated back for completion, and this along with the other steps helped reduce the overall days that A/R was outstanding. Several existing insurance contracts with extremely low rates were renegotiated over the course of a 2-year period to ensure that the contract rates were the best available. This all resulted in a significant increase in the collection percentage, meaning higher overall revenue for the practice. The average collection per patient increased by 16.2% to $138.18 per patient visit.