Healthcare/Revenue
Cycle Management
Improved AR Recovery with impressive ROI
Our Behavioral Health Organization Solution
The Challenge
The client is one of the leading Brooklyn-based behavioural health organization committed to addressing the root causes and problems associated with mental illness and substance and alcohol abuse, with more than 300 employees operating with five outpatient clinics. When we took on this account, we realized that the revenue performance indicators were significantly below optimal numbers. Additionally, the backlog volume across the billing processes posed a significant threat to the financial health of the mental health provider.
Our Solution
After having detailed conversations with the client's leadership, we recognized that the processes needed a comprehensive transformation program to improve metrics. We involved our AR experts team to do a detailed analysis of the current outstanding AR and the reasons for higher denials. Based on our studay, we established a process to categorize denials, identify the root cause, and implement corrective actions. Additionally, we also institutionalized the identified improvement areas through improved tracking, reporting, and feedback to the front-end team to avoid denials.
Benefits
With Pride BPO, the hospital was able to reduce their AR days from 55 days to 38 days and the 120+ days in AR reduced from 40% to 18%. We also helped to improve their eligibility success rate from 75% to 93%.
Our Benefits Verification Solution
The Challenge
Managing eligibility and benefits verification was an ongoing challenge for the client. Its agents were spending hours on the phone calls or looking at the payers' portals for coverage information. The client needed a way to make the process more efficient to provide more effective service to its customers. Errors in the eligibility verification process can lead to denials and write-offs if a patient wasn't covered for a service rendered.
Our Solution
Pride BPO worked with the client and helped to automate the retrieval of eligibility and benefits information through AI. This removed the potential for human errors and made managing verifications more effective, enabling faster, more accurate verifications so the client's provider customers can get paid on time and in full while better serving their patients.
Benefits
The behavioural health organization streamlined its eligibility and benefits verification process and was able to better serve its patients. The average per day eligibility verification increased from 50 to 200 and the cost was reduced by 40%. It also helped to reduce eligibility or benefits-related claim denials.
