Our most recent specialized provider client was a large dialysis center consisting of over 300 clinical sites nationwide. They contracted with us to reform their clinical documentation programs and assess their operational functions and ultimately, their revenue potential. We started the engagement by conducting a manual review of the clinical documentation for the billing of approximately 5,000,000 claims. We then organized the required data for 70,000 patients for successful claim submission to the Fiscal Intermediary. The outcome of the extensive documentation review project led us to create an automated web-based medical necessity scrubber to conduct thorough quality checks of all claims set to be submitted. We then used this QA tool to develop a web-based front-end medical necessity program for use at all clinic sites and suitable training modules on medical necessity for all levels of staff.

The in-depth operational assessment of the facilities’ billing processes allowed us to recommend unique process changes to best fit the dynamic of the organization. We also created comprehensive educational materials and workshops for the on-site clinical staff. Lastly, from our analysis, we prepared innovative work flows for the central billing office to increase staff efficiency, and also provided recommendations for a new billing system.

The adaptation of our recommendations and the implementation of our process changes allowed this organization to positively turn around its clinical documentation program and drastically boost billing efficiency and accuracy. The client paired itself with the ideal billing system for its particular business lines via our recommendation and was successful in billing all of its claims which allowed them to recoup more net revenue than they had actually projected.

Hospital Case Studies

Physician Practice Case Studies

Specialized Provider Case Studies