How Backoffice Pro Transformed Claim Management and Reduced Rejections by 60% for a Houston Practice

The Overview

• Client Profile: A Houston-based family practice focused on geriatric medicine, offering extensive healthcare solutions for individuals aged 65 and above.
• Company Size and Revenue: A small practice experiencing operational hurdles that impacted revenue streams due to high claim rejection rates.
• Industry Domain: Healthcare, with a specialization in geriatric care.
• Challenge Faced: The client encountered substantial operational inefficiencies due to inaccurate data mapping, insufficient follow-up on rejected claims, and incomplete patient information. These challenges led to increased claim rejections and financial losses.
• Project Objective: To lower claim rejection rates, streamline operational processes, and improve data management accuracy.

The Solution

Backoffice Pro devised a targeted strategy to tackle the client's issues, concentrating on data accuracy, efficient claims management, and staff training. Key aspects of our solution included:

• Comprehensive Data Accuracy Evaluation: We established a system to assess all incoming data for accuracy, eliminating inaccuracies to maintain a high-quality dataset.
• Robust Data Mapping System: Developed a dependable data mapping process to eradicate errors, which included testing with use cases and setting up a maintenance program for regular updates.
• Streamlined Rejection Management: Implemented an intuitive reporting system for claim denials aligned with workflow to enhance efficiency. Staff received training to ensure accurate information collection.

The Outcome

Backoffice Pro's strategic intervention significantly enhanced the client’s operations, delivering several key benefits:

• Reduced Claim Rejections: A notable decrease in claim rejections and underpayments, ensuring maximum claims processing and minimizing delays.
• Improved Data Accuracy: The precise data mapping system bolstered patient data accuracy and increased the efficiency of front-desk operations.
• Enhanced Operational Efficiency: The overall workflow was streamlined, leading to superior customer service and operational improvements.