Decreasing Insurance Accounts Receivable for Higher Revenue and an Improved Customer Experience
Overview
Premier Vision Group (PVG), an Ohio-based eyecare provider network, combines technology, passionate people, and research to care for patients’ vision needs while ensuring a memorable and productive eye-care experience. By adopting Knack RCM’s revenue cycle management solutions, PVG decreased insurance accounts receivable and increased average monthly revenue significantly.
Challenge
In 2017, PVG found that tracking appropriate billing and coding and keeping accounts receivable low were becoming exceedingly challenging. So much so that insurance accounts receivables made up 137% of average monthly revenue. The company decided it needed a solution that would enable it to improve insurance accounts receivable and, in the process, meet—and preferably exceed—patients’ vision needs.
Success in this initiative depended upon adopting a solution that delivered a measurable impact on average monthly revenue while remaining compliant and aligned with PVG’s mission to develop a deep understanding of eye care and foster a trusting relationship with patients.
Premier Vision Group turned to Knack to:
- Reduce insurance accounts receivable to 68.5% of PVG’s average monthly revenue — a 50% reduction
- Ensure that ethical and compliant billing and coding were being managed appropriately in an increasingly accountable healthcare environment
- Conduct appropriate follow-up with insurers after submission to ensure proper reimbursement
- Manage payments from insurers to lower accounts receivable as much as possible
Solution
To address PVG’s challenges and meet its objectives, Knack provided a suite of revenue cycle management tools — solutions that could be leveraged to deliver on four key areas:
Claims Scrubbing
Initially, view all submitted claims and ensure that diagnosis codes are linked with the appropriate procedure codes. This assures the best chance of successful payment on the first submission.
QA
If there are issues, the Knack team works directly with PVG employees through a HIPAA-compliant portal to clarify the claim prior to submission.
Denial Management
All submitted payments are posted from insurers and provide appropriate descriptions for services that may have gone toward a patient’s deductible through a secure connection via PVG’s electronic medical records software. If a claim is denied, the company researches and reviews the claim, assuring the best chance of appropriate payment to the practice for services rendered.
Ongoing Support
Knack provides HIPAA education and yearly chart
reviews to assure compliance while helping clinicians sharpen their ability to appropriately code for the
services they provide. It also provides effective
credentialing services for new hires
Results
Soon after partnering with Knack, PVG saw insurance accounts receivable sharply decrease. After only the first year, it was down to 62% of average monthly revenue In addition, improved efficiencies achieved as a result of Knack’s support enhanced PVG’s customer and employee experience.
With Knack’s RCM solutions in place, PVG was able to avoid staff reductions, instead reallocating their existing team to focus more on patient care. This strategic shift not only enhanced patient satisfaction but also significantly improved the efficiency of their operations. The improved financial performance and streamlined workflows ultimately allowed the service to pay for itself.