CASE STUDY

The provider was using an end to end RCM and wanted to evaluate the effectiveness of its RCM’s performance. Additionally, the provider wanted to establish a method for monitoring and evaluating the performance of its RCM.

Approach

A billing audit was performed to assess:

the practice’s collection rate
the effectiveness of the coordination and communication between members of the revenue cycle team (front desk, coder, biller);
any patterns in denials,
the percentage of denied claims that were worked– the percentage of corrected claims and/or appeals that were filed; and
the extent to which older A/R was collected

Result

The reporting of A/R collections lacked transparency, and audit findings indicated that the RCM collection practices required improvement.

RCM metrics were implemented.
Improved controls were established by the practice to monitor and identify issues with the RCM’s performance earlier.

Testimonial

I appreciate the expertise and professionalism of Sabrina Skeldon. Initially, I hired her to assist in the delivery of a compliance program for my practice. She was extremely knowledgeable on regulatory compliance issues and provided outstanding services. She educated me on everything from beginning to end. Based on my experience, I hired her to evaluate the performance of my RCM. Her recommendations highlighted weaknesses in the RCM’s processes that had slowed and limited recovery of revenue. She was responsive to my practice’s needs. I highly recommend her.

Dr. Arif

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