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Interventional radiology practice eliminates manual policy reviews

Picture this…you’re a six-physician, hospital-based interventional radiology practice who thought their denial rate was typical among their provider type. After a value assessment from Aptarro, it was clear revenue cycle process improvement was needed. Medical necessity denials comprised most of their coding issues. Medicare and Medicaid coverage determinations (LCD/NCD) and commercial payer policy guidelines were frequently changing and required a manual review of the policies for updates.

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The results

TOUCH
$7.2M total billed claims
$7.2M total billed claims

$7.2M total billed claims

TOUCH
$1.86M total billed errors* identified
$1.86M total billed errors* identified

$1.86M total billed errors* identified

TOUCH
25.8% total services billed with errors
25.8% total services billed with errors

25.8% total services billed with errors

The results

radar
 

Reduced/Reallocated

 

10+ FTEs
 
accuracy
 

Reduced Time

 

from date of service to claim submission by two days
optimization
 

Decreased

 

clearinghouse and payer rejections by 3%
atom-green
 

Improved

 

claim resolution rate by 25%
 
 
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The challenge

Printed versions of policies specific to the services they performed were maintained, but keeping the most recent policy available was time consuming and often resulted in missed updates.

The solution

With Aptarro’s hosted, SaaS-based platform, the full suite of edits and content are updated every 3-4 weeks,  ensuring the most recent version of a payer’s coverage guidelines are available for editing.

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Proof

Real, satisfied customers

“I love the reports. They are a key tool in our monthly board meetings and revenue cycle board meetings, helping me demonstrate the ROI of RevCycle Engine. They provide a clear picture of how much work is being fixed before it ever becomes a problem, which is invaluable for keeping leadership informed.”  

Director of Revenue Cycle

The providers are engaged in creating rules themselves. They’re asking, ‘Can this scenario be built into RevCycle Engine?’ They’re starting to think of clever ways to make the system work for them, even in smaller pain points. The physicians are most thrilled about how much less work they must do, such as ordering of codes. Engagement continues with new rules being added weekly.”

Director of Revenue Cycle

The benefits

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The group was able to reduce two full-time positions and reallocate another two full-time positions on their Charge Entry Team. They reduced 11 hours per day of manual charge entry; and automated charge cloning, missing charge reconciliation, and practice transfer. On their AR Team, they were able to reduce four and a half full-time positions and reduce denial tasks by 22%. Finally, on their Coding Team, they were able to reduce two fulltime positions and reduce coding denial tasks by 75%. In all, they were able to reduce or reallocate over ten full-time positions.

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In addition to remedying their staffing challenges, these changes positively increased staff morale and allowed for more professional growth among their existing staff. The simplified processes also eased staffing changeovers and reduced the administrative burden on IT.

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The time from date of service to claim submission was reduced by two days. Their clearinghouse and payer rejections decreased by 3%, backend rejections went from 40% of total rejections down to 15%, and their claim resolution rate three months after implementation was up by 25% of the available opportunity.

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