Case Studies
Case 1
Underbilling & Leaving Your Money On The Table
We brought on a therapist who was at their wits end with trying to bill BCBS and not bringing in what they thought they deserved andexpected. Right away, the new billing specialist was able to identify several claims which were underbilled and not paid at the usual andcustomary rates. Claims were corrected, resubmitted, and a check for over $1,000 was in the providers bank account, all in less than 1 week!It turns out the provider was underbilling and missing out on over $30 dollars per visit. Now the provider is bringing in the money theydeserve & are breathing easier when it comes to this single provider’s bottom line!
Case 2
40% Decrease In Claim Denials & 60% Increase In Patient Collections
As billers, we understand how important it is to verify insurance eligibility & collect estimated patient dues such as Deductibles and Copays.A multi-provider behavioral health clinic contacted us concerned that too many of their claims were being rejected by insurance companiesand money wasn’t coming in from the insurance companies or patients. After implementing a new Insurance Eligibility and Patient CostShare Estimate Protocol in the offi ce, they were able to see a 40% decrease in claim denials and increase their patient collections by 60%!
Case 3
Coding Issues & Lost Revenue Opportunities
CPT codes and Diagnosis codes are constantly changing. Insurance Companies send never-ending policy and billing guideline updates. It’sno wonder so many providers feel lost and overwhelmed when it comes to medical billing and coding. For instance, a multi-provider groupcontacted us due to their piling up denials and suff ering bottom line. After a quick claims audit, the billing specialist was able to identifyseveral codes which were billed but had expired. The billing specialist worked diligently to gather the updated codes and billing guidelines.The providers’ superbills were updated & they were trained on the correct codes to bill and how to identify when extended services werebillable. Previously denied claims were resubmitted to recoup lost revenue. As a result, their rejections decreased by 30% and theircollections increased now that they were billing for all of their time spent rendering services correctly.
Case 4
Missing Insurance Payments
We were contacted by a provider who was distraught and missing thousands of dollars’ worth of payments from insurance companies. Itturns out her previous biller had written off her concerns noting that their job was billing, and tracking down payments was not part of theirjob description. After hours of being transferred from insurance rep to insurance rep, the provider assumed the money was gone for good.Well, that was until she contacted us. After investigating it turned out her checks were being mailed to the wrong address & put into alocked mailbox that was no longer being checked on. Her new billing specialist not only worked with the insurance companies to update theprovider’s information in their systems, but also had the provider set up with direct deposit payments to the provider. All of the lostpayments were re-issued and in the provider’s bank account within 1 month’s time!
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