Healthcare Provider Boosts Revenue with a 30% Reduction in Denial Rates with Backoffice Pro

The Overview

• Client Profile: A North Carolina-based healthcare provider specializing in orthopedic treatments.
• Industry Domain: Healthcare
• Challenge Faced: The client needed to optimize their medical billing practices, ensuring precise, timely charge entry, boosting private and government health insurance plan participation, and adhering to industry standards like NUCC, CMS, and HIPAA while meeting insurance company requirements.
• Project Objective: To streamline medical billing procedures with a comprehensive solution that enhances claim generation, boosts insurance plan strategies, ensures compliance, and refines charge entry procedures.

The Solution

Backoffice Pro developed a comprehensive and strategic billing solution to meet the client's needs. The solution aimed to improve coordination of patient services, claims generation, quality assurance, and financial management. Key aspects of the solution included:

• Streamlined Processes: By collaborating with medical experts for service accuracy, maintaining comprehensive billing records, producing uniform claims following NUCC standards, and enabling efficient electronic claims and records management.
• Rigorous Quality Control: By forming a dedicated team to review bills, ensuring accuracy in billing minor services with CPT codes, and handling various transactions including insurance payments, adjustments, and denials.
• Enhanced Revenue Management: By adopting meticulous charge capture processes to optimize financial management and patient service coordination.

The Outcome

The solution brought significant improvements for the client, optimizing the billing efficiency, ensuring timely and accurate payments to healthcare providers, and providing detailed insights into receivables. The outcomes included:

• Optimized Billing Process: Streamlined billing process, resulting in accurate and timely payments.
• Enhanced Receivables Management: Comprehensive insights into receivables enabled proactive and effective follow-up actions.
• Significant Denial Reduction: Achieved a remarkable 30% reduction in initial denial rates within the first three months of implementation.

Conclusion

Backoffice Pro's tailor-made solution not only streamlined the client's medical billing procedures but also boosted their overall revenue management. With extensive expertise in the healthcare BPO sector, Backoffice Pro is the go-to partner for healthcare providers looking for reliable and profitable solutions.