We performed the following steps:
- Created a single point of contact to the practice
- Created website accesses to all payers who offered services to the client
- With the upgraded PMS, we drew out detailed open item reports
- We generated a line by line analysis report on the status of all unpaid lines and assigned status codes
- Our status codes revealed transmission issues, which we immediately rectified
- High dollar drugs which remained unpaid were analyzed and issues were resolved with the help of payer
specific guidelines and medical records
- We corrected claims and re-filed them immediately
- New reports were generated every 25 days to monitor the reduction in accounts receivable over each aging bucket. Non-payable codes were written-off after discussing them with the client
- Timely filing denials were appealed with proof
- Unpaid procedure codes were researched for bundling and modifiers were then used wherever appropriate
- We performed a drug audit for all claims going back three years. Incorrect adjustments were reversed and
claims were sent for review. Wastages were identified and billed to Medicare
- We generated authorization requests with HMOs and built up a database of all such patients. We provided
early warning alerts to the client when authorization terms were going to end. We checked periodically
during each authorization span to see if there were any changes in treatment regimen.
- A comprehensive Practice Management Report was drawn at the end of the month, which revealed
the health of accounts receivable and the client’s practice. We provided data on the number of new patients
seen per month over the past 2 years
- We generated Patient Statements and performed timely follow-up with patients We inquired on patient satisfaction levels and forwarded patient feedback to our client
- We reduced accounts receivable by 25% within the first 30 days of operation
- At the end of 90 days, we had a comprehensive list of patients, their regimen, and their authorization status
- 120 days into our assistance, our client had payments coming in from incorrectly adjusted charges and low-paid drugs
- Patient satisfaction scores hit the ceiling
- The client’s number
- of patients steadily increased from 60 days onwards since staff had more time available
How We Increased Revenue and Decreased Days in A/R:
- Decreased Denials: Purple KPO’s cloud-based charge capture software includes a rules engine
with 15 million+ payer specific rules. This rules database identifies errors before claims leave the office.
Submitting clean claims played a key role in reducing denials and days in A/R
- Reduced Eligibility Denials: We checked eligibility on all patient encounters prior to claim transmission, which reduced benefit related denials across the board. Our insurance eligibility tool also displays patient co-pays making it easier for staff to collect patient payments during the office visit
- Charge Reconciliation: Purple KPO’s charge reconciliation solution ensured that Client B captured 100%
of the revenue associated with patient care
- Enforced Payer Contracts: On average, commercial insurance carriers underpay claims by 7%.
With Purple KPO’s payer contract compliance and client-specific payer knowledge base, we were able to identify and appeal all underpaid claims
Client A - The Challenge
The practice had overworked employees struggling with limited knowledge on medical billing.
Valuable time was spent on billing and accounts receivables by employees who were masters in clinical details. Employee frustration effected patient satisfaction scores and the number of patients dwindled over time.
Collections from insurance could not be monitored and appeals on denials were a far fantasy. Add to an ancient practice management system added to its woes.
Bottom line: Patient billing was on the rocks
Puple KPO’s Approach
We took over all activity starting with insurance verification and established 24/7 connectivity to the client’s practice management system.
"It is rare to find a business partner who is selfless.
If you are lucky it happens once in a lifetime.”
Purple KPO is an established premier healthcare KPO services provider for more than 15 years.
Start your journey with Purple KPO today.
Client B - The Challenge
A California-based practice that treats 180 patients per week. Prior to Purple KPO, they outsourced its billing to a small billing agency. The biller filed claims once every two weeks after visiting the office to either pick up or drop off billing information including super bills, EOBS, and lists of patient payments. Our client had limited staffing resources and attempted to keep up with the daily grind of manually verifying eligibility as well as managing the details of correctly entering patient demographics and insurance information into an antiquated DOS-based practice management system.