FWS Provided Medical Billing Support to the largest US-based Medical Billing Services Administrator

Case Study on Medical Billing Support to US Client

The Client

The client has outsourced few major accounts and subprocess of healthcare services to Flatworld Solutions in the recent past. They are also the largest third-party administrator offering fully customized medical billing services in the US to maximize profitability by catering to all business process outsourcing needs.

The client is a medical billing consulting firm that delivers timely services to their clientele (doctors and healthcare facility). They expressed keenness to maximize the earning potential by reducing the practice expense and increasing the bottom line. Hence, the client was left with 100 plus (Clients/Doctors) Medical Billing accounts to process without impacting the business value or causing dissatisfaction.

Client Requirements and Challenges

For the period starting from July-17, Flatworld had received three major businesses (eligibility & benefit verification, pre-authorization, and A/R follow-up). We were tasked to check the eligibility along with pre-authorization requirement before rendering the service for patients (All that within 2 days). We had 30+ clinical sleep study questionnaires to be answered with an eye on pre-authorizations.

Inadequate knowledge of home and lab-based sleep study services to justify the medical necessity posed a challenge as it led to claims denial. The denied claims had to be reprocessed for payment on A/R follow-ups.

FWS' Solution

Flatworld actioned on the client's need by assigning the task to a team of medical billing experts. Our team took stock of the challenge to formulate a solution that improved cash flow and collection. We handled the client challenge as follows -

  • Steadily discussed specialty subject matter (Sleep Study Services) with the client in daily review meeting for a couple of months
  • Formed a dedicated team who concentrated on the subject and efficiently interpreted different dialects of each dictator to smoothen the work process
  • Shift timing changed to EST to facilitate support in the client's local time zone
  • Provided root cause analysis for the latest major denial to fix errors at entry level to gradually reduce the denial

Offered Billing Services (RCM)

Offered Billing Services

Denial Analysis Trend

Denial Analysis Trend

Results

With the project completion, we ensured that the client was satisfied with our solution and timely support. The client experienced the following benefits by outsourcing billing functions to us -

  • Eligibility and benefits verification had been performed within the timeline
  • A/R load was reduced from month-on-month
  • Client satisfaction and business growth was achieved

Partner with Flatworld Solutions - Leader in Healthcare BPO

Flatworld Solutions is an ISO 9001:2013 certified company with 15 years of experience in commercial healthcare BPO services. We offer a range of billing solutions that include medical billing services. With this solution, you could among many happy clients we serve who have successfully scaled up the business to bring in revenue and growth. Our ISO/IEC 27001:2015 certified security policies are aimed to protect your clinical data from unauthorized access and modification. We also provide a transparent service and support so that you understand how we ensure that your practice can stay focused on other important business facets. We also offer other healthcare BPO services such as CPT & ICD-10 coding, Accounts receivables services, patient demographic entry and more.

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