Eight Provider Orthopedic Billing Case Study

The background: The group was outsourcing their orthopedic billing with a mid-size, generalist billing company. The physician providers were working harder for increasingly lower reimbursements. 

The orthopedic billing challenge: The collection ratios (after contractual adjustments) were under 70% and the average days in AR were over 90 days. Less than 65% of claims were submitted clean. The billing system did not provide meaningful financial reporting/analysis to the Administrator and marketing coordinators. The orthopedic billing process was not measured and systematic. 

ClaimCare's orthopedic billing solution: We provided a state of the art orthopedic billing system, process and interactive reporting. We analyzed the process flow then designed and introduced reporting/quality control.  Our proprietary "claim scrubbers" analyzed all claims going out.  Our allowable scrubbers tracked payments and insurers' underpayments.  Every step was now measurable.

The orthopedic billing results: Within 3 months of implementation, the group had the best orthopedic billing month ever! Within 6-8 months the revenues were up 73% on the same volume/payer mix. The reporting allowed the practice to improve contracting and exit unprofitable procedure-lines.  Additional reporting allowed them to improve front desk employees' productivity (co-pay collections, demographic gathering).