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Using Automation to Pinpoint Opportunities for Revenue Cycle Improvement

Practices that want to thrive in the current healthcare environment must have deep insight into their performance on key revenue cycle metrics. That’s why Texas Retina Associates—a 14-office sub-specialty ophthalmology practice—began looking for ways to easily quantify rejections and denials. The group wanted to be able to scrutinize the data and identify opportunities for improvement.

The goal was to proactively address any trends in the revenue cycle that were negatively affecting the number of rejected and denied claims. The practice believed that uncovering the root causes of rejections and denials would have a powerful impact on the entire revenue cycle.

As it turns out, they were right. Putting a vigorous analysis tool to work recently helped one of the practice’s locations pinpoint an uptick in rejections. The practice traced it back to a new staff member who was incorrectly entering insurance information on certain claims, which caused those claims to reject—and then required a back-end fix. By working with the staff member to correct the problem upfront—as well as making a small adjustment to the group’s practice management software— Texas Retina Associates has been able to avoid similar rejections.

As a result of this and other improvements enabled by the analysis tool, the rejection rate at Texas Retina Associates has dropped nearly 20 percent. The practice saves a lot of time, too. Practice managers now use the tool to prepare professional, easy-to-read reports full of valuable information—in some cases information that couldn’t be accessed before—with a few mouse clicks.

At the staff level, employees have greatly reduced the time spent fixing unnecessary rejections, for instance, because they can efficiently locate and resolve problems prior to claim submission. Claims go out faster and are processed faster because front-end demographic and insurance errors have been reduced. As a consequence, the group’s days in A/R have been trending down. Even factoring in the conversion to 5010, average A/R has been hovering at around 21 days.

Texas Retina Associates attributes much of its new fiscal efficiency to analysis tools that have helped it gain an appreciation for the root causes of previous problems. Now the group looks forward to launching well-targeted improvement efforts, and responding quickly to ever-changing trends.