Our client, a mid-sized hospital group, faced challenges getting reimbursed for ED visits. Sub-optimal client documentation processes led to delayed payments and reduced reimbursements. Our initial analysis revealed that delayed billing was the root cause. We conducted an exhaustive internal audit of 30 physicians working across two facilities in Washington and Florida. In this case study, we highlight how improved clinical documentation and coding quality lead to increased reimbursements.

Our client, a Maryland-based Medical Billing & Coding Company, was challenged with billing & coding for all vaccinations done at an urgent care clinic in North Carolina. The urgent care center had partnered with the North Carolina Department of Health & Human Services, thereby conduction the majority of the Vaccination drives at their care centers. In this case study, we share the best practices applied by our team while billing & coding for COVID-19 vaccination.

Amidst the uncertainties of the pandemic, our client, a healthcare provider in Central Florida, had launched Covid-19 testing for both insurers and non-insured patients. Although the client got reimbursed successfully for the insured patients' claims, they were looking for a third-party RCM management company like MBW to help them submit claims electronically under the HRSA program. In this case study, read more about how our team helped collect $60k with a first-pass claim submission rate for Covid testing under the HRSA program.

Invalid Diagnosis codes can cause coding errors and inflate claim denial rates. Often, healthcare providers tend to utilize superbills and mark the nearest available codes on the superbills. One of our clients, a podiatry provider, used superbills. The providers habitually marked the 99309 procedure on the superbill and notified the billing team for processing. However, as per Medicare and Medicaid regulations, 99309 and 99252 need to be entered for the claims to get reimbursements. Due to the lack of a clear understanding of the coding guidelines, the providers marked invalid diagnosis codes on the superbill.

Understanding California, Payer, and Behavioral health-specific nuances and diligent focus on enrollment, timely filing, and payments reconciliations reduced denial rates and increased collections by 52%.

Many Primary Care Physicians lose money because of lack of understanding of payer specific claims submission guidelines. Educating physicians on their documentation responsibilities is an iterative process, that requires an understanding of the reasons for claim denials, ability to nail-down the issues that are causing the denials, determining the corrective actions, and hosting timely sessions between the denials team and the physicians to discuss them.

Bad quality scanning of superbills and lack of adoption of electronic claims submission creates a charge backlog situation and consequently, result in increased denials on account to timely filing dates not being adhered to. Read this case study about how our structured approach, technical expertise, and revenue cycle rigor combine to create value for our client.

Most revenue cycle systems have a wealth of unutilized functionality. Revenue cycle professionals need to evaluate workflow and reporting functionality on the revenue cycle system to not only ease their workload but also improve revenue cycle outcomes. Read more in this case study.

Notice of Levy issues may be wrongly construed to be claim denials if a thorough investigation is not done to understand the reason behind such cases. Further, it is imperative that physicians pay their taxes on time. By educating physicians/practice teams on the importance of filing taxes, an artificial surge in denials on account of notice of levy cases can be avoided.

Physical Therapy billing requires expertise to ensure holistic and sustainable improvement. Medical Necessity and prior authorization issues can cripple a practice’s financial health. Structured revenue cycle processes can help Physical Therapy clinics grow and thrive. Diligent tracking of issues and working with physicians can yield as much as 2X improvement in collections and reduce denials by as much as 50%. Get the strategies in this case study.

Worker’s Comp Claims present unique challenges to billers and claims follow-up agents. By following the processes and guidelines outlined by the Payer, you can improve collections multi-fold.

While the application of prolonged service codes may be fairly simple, very few codes cause more confusion than prolonged service codes. It may be noted that prolonged service codes can be used for outpatient procedures as well as for inpatient care. These codes are typically used to bill for services that significantly exceed the standard time a physician takes while providing care. These may include face-to-face services as well as non-face-to-face services.

While prolonged service coding issues are highlighted in this case study, the principles of educating physicians and clinical staff is applicable for all cases where coding denials are high.

Recovering claim dues from payers for physician assistance claims requires intricate knowledge of payer-specific guidelines. Medical Billing Wholesalers’ denials research team helped the client identify and resolve out-of-network claims.

With a focus on recovering denials of PA claims from UHC and Oxford, we rebilled the claims after adhering to the payer-specific guidelines and were able to recover over $80K of A/R, while reducing the monthly denials from 73 to 11.

Standardized billing and coding practices for Spinal Cord Stimulator (SCS) Procedure Code 63650 reduce medical necessity denials and help collect 281 claims valued over $ 300K in 2 years. The Customer saw over 36% improvement in Collections, as much as 75% reduction in old AR over 61 days, and reduction of denied SCS claims from 68 to 8 over a 7 month period.