Case Studies

Overcoming Insurance Eligibility & Benefits Verification Challenges for a Prominent Consulting Firm in Minnesota

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Established in 2009, our client is a leading Minnesota-based Medical Billing and Consulting Leader, offering a comprehensive range of specialized services for over 100+ diverse medical accounts. Their expertise spans revenue cycle management, precise claims processing, insurance verification, benefits validation, coding optimization, and unwavering compliance.

In line with their ongoing dedication to process enhancement, the client aimed to establish a seamless eligibility verification process, ensuring accurate claims processing and timely payments without delays.

The Story of our Customer

Founded in 2009, our client is a prominent Minnesota-based Medical Billing and Consulting Leader. They provide a comprehensive array of specialized services, including advanced medical billing and tailored consulting solutions for over 100+ diverse medical accounts (Clients/Doctors).

With almost 15 years in the industry, the company has built reputable client relationships through advanced back-end support and innovative technology, boosting client profitability.

Their services encompass intricate revenue cycle management, precise claims processing, thorough insurance eligibility verification, benefits validation, strategic coding optimization, and unwavering compliance with regulations and industry standards.

The challenge faced by our Customer

  • Implementing an efficient and streamlined eligibility verification process to enhance operational efficiency.
  • Ensuring precision in claims processing to minimize errors and improve overall billing accuracy.
  • Mitigating the risk of payment delays to clients by optimizing the claims submission and validation procedures.

The Solution

We executed a comprehensive approach to optimize the client's insurance eligibility and benefits verification process, which can be summarized as follows:

  • Dedicated verification team, trained and integrated with client's staff.
  • Streamlined verification documents.
  • Pre-appointment protocol with 48-hour lead time.
  • Real-time walk-in patient verification, 1 hour before appointments.
  • Swift insurance authorization and referrals.
  • Timely insurance issue resolution for efficiency and satisfaction.

The Result

  • Empowered pre-registration staff with streamlined insurance verification, reducing costs and expanding roles.
  • Achieved 50% coverage query fee reduction, saving $60,000 annually.
  • Significantly lowered coverage denials from 8% to 2%, in line with best practices.
  • Enabled industry-leading admissions and financial clearance practices.
  • Cut eligibility FTEs by 80%, reducing staff from 5 to 1 with OutsourceRCM' seamless services.

Leverage OutsourceRCM to Serve the Customers Better

OutsourceRCM stands as a premier business process outsourcing firm, boasting skilled professionals located within 5 global delivery centers worldwide. Our comprehensive array of services spans inbound support to outbound call center solutions, providing a holistic resource encompassing human expertise, process acumen, advanced technology, infrastructure support, and rigorous quality assurance measures – all geared toward amplifying the scalability of your business operations.

If you seek a dependable, lucrative, and synergistic healthcare BPO partner to realize your goals, we encourage you to establish prompt contact with us