Case Studies

A KY Based LAB services center needed a claims clearinghouse that could help to decrease the days in A/R and to streamline their LAB billing process and to manage the overall revenue cycle management process for a positive impact on cash flow.

CHALLENGES

1. Absence of latest annual release codes for LAB billing procedures.
2. Many submitted Claims did not reach the payors
3. Less than normal reimbursement from payors (CPT based)

SOLUTIONS

1. Velan identified the correct lab codes for the year 2017 and submitted the sample claims to the insurance(s) and made concurrent follow-ups to get the claims processed.
2. Velan found that there is a system error in the payor and the payor ID was not updated in the clearinghouse. Sample claims were processed by fixing the identified issues and by concurrent follow-ups with the clearinghouse and the payor.
3. Due to an internal error in the payor system, allowed reimbursement for the CPT was not done. Velan sent all the less reimbursed claims for reprocessing with a concurrent follow-up with the payor

RESULTS

1. Cash flow improved month over month with a decrease in coding related denials by 30%
2. All the claims were sent for processing by the payor for a single reimbursement, which resulted in a 15% increased cash flow.
3. Started receiving allowed reimbursement for the CPTs which resulted in 10% increased cash flow.