62% decrease in operating costs and 23% increase in revenue, for a durable medical equipment provider

Problem:

The client is a DME (Durable Medical Equipment) provider in the United States. Our client had both Home Health and DME provider services for many customers. However, they were not able to bill claims to insurance companies on time, along with the required authorization for each service. Their list of problems are:

They were not able to enter claims in their billing software and client database on time
Authorization for DME products and Home Health Services were not taken on time
High operating cost of in-house billing team
Higher attrition of in-house billing team
Many claims were not getting completed based due to different denials
Less expertise in DME Coding and Billing among the team

While their in-house team was not able to handle the DME Coding and Billing on time and improve the revenue, it was also proving to be too expensive for the client to keep the Medical Coding and Billing Team operations in-house. Due to this, they were getting a lot of claims denials, losing money, incorrect coding, less revenue overall for the DME provider.

Client’s expectation from Integra

Our client wanted us to handle all the aspects of RCM including Medical Coding, Prior Authorization, Template, Patient Log updating, Patient Chart Creation, Demo, Insurance Eligibility, Charge Posting, Claim Submission (Electronic & Paper claims), Rejection, Payment Posting (Manual EOB & ERA), Denial Management, Insurance Follow-up, Patient Statement, live communication to client on daily basis through Business Skype, E-mail and Calls. We send daily, weekly and monthly reports to the DME Provider. We enter Daily Visits in the client database to track the about to expire authorization report and request reauthorization. Also, we run daily open visits reports, weekly and monthly reports.

Our solution to the problem 💡

We set up an experienced DME coding, billing and insurance follow-up team who work along with DME Provider to complete all tasks. The team was established in a very short span of time; they were trained quickly in all aspects of the client's business.

Our team expertise helped the DME Provider to fix coding related denials, do correct coding based on insurance guidelines, get prior authorization on time to submit clean claims, verify Insurance Eligibility to make sure provider receive the payment from insurance company, enter accurate patient information in software, enter the service details, submit the claims on time, work on any rejection swiftly to resubmit the claims, post the ERA payments, manual EOBS on time, work on the denial, insurance follow-up and patient statement. We have experience in multiple practice management software.

RCM Team were able to focus on all the above tasks with quick turnaround time, good quality and in-turn improved the overall revenue for the DME provider within a few months. The efficiency of the team helped to manage the RCM services with reduced operating costs by about 62%. Their revenue also increased by 23%.

Tasks handled 📋

Medical Coding and related denials
Prior Authorization and Insurance Eligibility Verification
Patient Chart Creation, Demo, Update Patient Log and Visit Entry in Database
Charge Posting
Electronic Claim Submission
Clearinghouse Rejection
Payment Posting
Denial Management
Insurance Follow-up
Patient Statement

Result 👍

Operation cost savings imporoved by 62%
Increased the Overall Revenue for DME Provider by 23%
Reduced Accounts Receivable Backlog
Decreased Denial

With Integra handling the RCM Services, our client is able to concentrate entirely on other areas of the business to win more customers. Our client trusts Integra entirely to fully manage the RCM Services.