Case Studies

Client

A Louisville, KY Based Family Medical Center

The Louisville Family Medical Center needed a claims clearinghouse that could help to decrease days in A/R and streamline their revenue cycle management process to positively impact cash flow.

Challenges

1. Incorrect and inadequate demographic entries made.
2. Lack of comprehensive selection of insurance plan by the provider.
3. Inadequate awareness of LAB billing procedures.

Solutions

1. Sample claims are processed based on the identified issues at the provider’s end to check compliance and acceptance. The claims are processed as expected and based on the outcome the entire batch was submitted and revenue earned.
2. Claims denials are categorized, prioritized and claims processed by experienced personnel for quick attention.
3. Velan uses real-time data from an internally developed knowledge base and taking input from the relevant authority (AHIMA). This enhanced the rate of compliance and assured revenue with a quick turnaround time to the provider.
4. Review of insurance plan enrolment was done to ensure comprehensive care delivery to the patients. This resulted in reduced ‘out of network’ coverage thereby increasing revenue substantially.

Results

1. Cash flow improved month on month with a decrease in 20% for Coding related denials
2. Correct submission of CLIA# for lab codes resulted in increased cash flow of 11%.
3. Backdated comprehensive Enrollment of insurance plans resulted in 10% increased revenue.
4. Overall from the induction of the provider within 10 months outstanding AR collection was reduced to 1/3rd