Overview
- The client is a family practice based in Houston, TX, specializing in Geriatric medicine, providing comprehensive healthcare solutions for individuals aged 65 and above.
- They faced challenges with their system, which included data flaws and ineffective reporting for claim denials, affecting their workflow efficiency.
- The issues were addressed by OutsourceRCM, who evaluated their system, rectified the data flaws, and introduced an effective reporting system, resulting in improved workflow and trained staff in accurate information handling.
The Story of our Customer
- The client, a Geriatric medicine practice in Houston, faced operational issues and financial setbacks due to claim rejections and data errors.
- OutsourceRCM improved data quality, data mapping, and rejection management, leading to a smoother workflow and better information accuracy.
- The solutions provided resulted in reduced claim rejections, improved staff performance, and superior customer service.
The challenge faced by our Customer
The client grappled with significant challenges within their operational processes that impeded their efficiency and revenue stream. These challenges resulted in elevated rates of claim rejections, delayed reimbursements, and potential financial setbacks for the client's family practice.
- Inaccurate data mapping between front-line client software.
- Inadequate follow-up and resubmission of rejected claims.
- Presence of incomplete or unverified patient information.
Our objective was to rectify mapping inaccuracies and ensure error-free claim submissions.
The Solution
The client faced a growing claim rejection rate due to data mapping issues, improper claim follow-up, and incomplete patient information. These issues led to financial setbacks and operational inefficiencies.
- Implement a comprehensive data accuracy evaluation system: This would involve evaluating all incoming data for accuracy and usability, and removing any inaccurate data to enhance the overall quality of the dataset.
- Develop a robust data mapping system: Create a reliable and precise data mapping approach that eliminates mapping errors. This system should include testing with use cases and a flexible maintenance program for regular updates.
- Streamline rejection management: Introduce an intuitive reporting system for denials with integrated design that aligns with workflow for increased efficiency. This solution should also involve training staff to ensure accurate information collection.
The Result
Our solution delivered the following benefits to the client:
- OutsourceRCM' solution led to the reduction in claim rejections and underpayments, ensuring maximum claims and avoiding unnecessary delays.
- The implementation of a precise data mapping system improved patient data accuracy and overall efficiency, enhancing the performance of front-desk staff.
- The workflow was significantly improved and streamlined, resulting in superior customer service and operational efficiency.
Elevate Customer Service with OutsourceRCM's
OutsourceRCM's is a top-tier BPO company offering global expertise from 5 delivery centers. Our inclusive services range from inbound support to outbound call solutions, delivering comprehensive resources for enhanced scalability.
For a reliable, profitable healthcare BPO partner, contact us today.
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