Case Studies

The healthcare industry is undergoing dramatic transformations. Consumers, employers, and governments worry about privacy, security and access to medical records. Healthcare payer organizations and providers are battling over coverage, medical necessity and treatment protocols.

MediXperts brings innovative leadership in our pursuit of new solutions that reduce costs and serve our clients and their customers more effectively and efficiently.

We present one such Case Study here -

Case I - Billing troubles

Pre-Outsourcing Issues with Client

A multi-specialty practice with 20 plus physicians at a Clinic in Central California was facing several issues resulting in non-payment of bills. As the rejected claim percentage rose substantially, MediXperts undertook a preliminary study to identify the major claim rejection issues.

Problem Detection

After a one-week study conducted by MediXperts' billing expert, following issues were identified. Claims being denied due to inaccurate coding –

• Resource constraint - only able to code/ verify 30-40% of the reports.
• Backlog of coding causing delay in claims submission.
• Complete relying on clinical system for codes with no coding audit by professional coders.
• Inaccurate design of Hospital Charge Master.
• Limited internal resources for supervision or process change management.

Solution

MediXperts recommended outsourcing the coding operation to MediXperts' coding facility, with CPC certified coders on ICD-9CM, CPT-4 and HCPCS.

For a risk free transition a pilot-coding job was taken up. The advantages envisaged due to outsourcing the coding function are -

• CPC Certified coders.
• Quality enforced by strict SLA and penalty clauses.
• Guaranteed turnaround time.
• 100% Code review [Coding Audit].
• Client Specific Customization of Coding Service.
• Using professional coding tools like Encoder Pro.
• Complete HIPAA security and transaction compliance.

Results  

After the pilot was run for a month the outcome was apparent.

• Denials due to inaccurate coding decreased substantially.
• Coding & Verifying all reports (No capacity constraints any longer).
• Optimized revenue levels (No down-coding/Up-coding).
• Backlog decreased.
• Freed up internal resources.
• Saved client's coding cost by 60%.

Client details and references can be provided to interested prospects.

See also - Success Stories