Introduction
This is the case reports in the cardiology facility located at Syracuse, New York, which struggled with high claim denials and slow appeals processes. Frequent documentation inconsistencies and incorrect CPT/ICD-10 coding were major contributors to claim rejections, which delayed reimbursements and negatively impacted the payment cycle.
We Medical Billing Wholesalers implemented a data-driven strategy to improve documentation, code accuracy, and strengthen provider education. As a result, the cardiology facility saw a 15% reduction in claim denials and a 67% improvement in appeal resolution speed.
Client Overview
The cardiology practice is a leading provider of specialised cardiac care.
Location: Syracuse, New York, USA
Our Service: Cardiology Billing Services
Initial Claim Denial Rate: 25%
Average Appeals Resolution Time: 60 days
Monthly Revenue Cycle Volume: $300,000
Average Monthly Collections: $171,000
Challenges
The cardiology practice was facing several challenges that both revenue flow and operational efficiency:
Incomplete Clinical Documentation: Handwritten notes lacked critical details, leading to claim rejections.
Frequent Coding Errors: Incorrect or incomplete coding led to a 25% claim denial rate, particularly in complex cases.
Non-Standardized Records: The absence of consistent documentation practices created billing discrepancies.
Delayed Physician Responses: Slow responses to coding inquiries delayed claim submissions, impacting the revenue stream.
Extended Resolution Periods: Appeals took, on average, 60 days to resolve, adding to administrative costs by 30%.
Our Approach
We carried out an in-depth analysis to uncover the underlying causes behind the cardiology facility’s high claim denial rates and prolonged appeals process. A multi-step strategy was crafted to upgrade documentation accuracy, optimize claim submissions, and automate the appeals workflow.
Analysis
The focus was on diagnosing patterns that contributed to errors and delays in the revenue cycle. Each solution was designed to tackle a specific issue, facilitating faster and more accurate claims processing while reducing the administrative burden.
Issue | Solution |
Incomplete clinical documentation leading to claim denials and financial setbacks. | A comprehensive medical records audit was implemented to catch discrepancies before submission, ensuring complete and compliant documentation. |
Manual follow-up processes were slow and inconsistent, delaying claim submissions. | An automated follow-up system was established to maintain consistent communication, reducing delays and manual workload. |
Incorrect and incomplete coding submissions increased claim denials to 25%. | Advanced training sessions were conducted to keep coding staff up-to-date on CPT and ICD-10 codes, boosting coding accuracy. |
Administrative overload hindered focus on critical tasks. | Key billing and follow-up processes were automated, allowing administrative staff to concentrate on high-value activities. |
The absence of a tracking system for unresolved claims led to payment delays. | A robust tracking system was developed to monitor the status of outstanding claims, ensuring timely follow-ups and resolutions. |
Results
- The claim denial rate dropped from 25% to 10%, marking a 60% enhancement in coding accuracy.
- The appeals resolution time decreased from 60 days to 20 days, a 67% quicker turnaround.
- Expenses related to denials and appeals were cut by 30% within 60 days.
- Total collections increased by 20%, climbing from $120,000 to $144,000 within three months.
Conclusion
Medical Billing Wholesalers’ customized solutions deliver measurable improvements for the cardiology practice. By addressing key pain points in claim management and appeals processes, the practice was able to significantly improve economic outcomes.
This case highlights the power of tailored Denial Management Services in optimizing revenue cycle performance.
