CASE STUDY:

RCM Consulting – Primary Care

OVERVIEW
EXECUTION
RESULTS
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RCM Consulting – Primary Care​ - Overview

SCALE was engaged by our Client to improve their overall performance in RCM and: 

  • Assess the RCM department’s overall functionality including the skill sets of the team members
  • Assist in interviewing Director and manager of RCM
  • Make recommendations on policy changes/adds
  • Assist in updating RCM procedures and processes
  • Update/ Implement workflow process
  • Increase the overall RCM performance
  • Draft SOP’s
  • Deliver industry standard KPI’s

Clinical Specialties

Clinical Services

Client Profile

  • Size:
    400+ Employees
  • Location:
    GA
  • Specialty:
    Primary Care

Services Deployed

Download the PDF

Revenue Cycle Management Consulting

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Execution

  • SCALE was engaged to assess and make recommendations on ways to improve the overall performance of our Client’s RCM team, and evaluate Allscripts performance in lifting or elevating the Client’s overall financial situation
  • We tracked the following weekly key metrics in our financial analysis:
  • Denials management
  • Coding
  • Eligibility
  • Payment posting – performed by Allscripts
  • SCALE utilized a practical and collaborative approach with the CFO/Director and support personnel to develop and expand the overall performance of the RCM department, using data to drive changes to processes and grade performance of RCM and Allscript team members
  • We reviewed policies as they related to the RCM department, overall operations of the department, and their impact on the financial deliverables
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Results

SCALE developed the following KPI’s, setting and meeting industry standard goals for our Client:

  • Coders 98% accuracy
  • Denials Management: No more than 15% AR in >90 day bucket
  • AR follow-up specialists: resolving payable claims within 35-45 days
  • Medical records turnaround within 30 days
  • Developed SOP’s
  • Streamlined the AR work queues for optimized return
  • Decreased claim lag time to 6 days
  • Decrease AR >90 day buckets to less than 20% overall outstanding debt
  • Front end coding accuracy at 62% vs 27% at start

Let's SCALE together

SCALE Healthcare is based on the foundation of a singular focus – elevating management performance across healthcare services. We are focused on the entire suite of operational advisory and diligence services exclusively to healthcare service organizations, with local team presence across 10 states.

Unlike the many consulting firms that offer more narrow and often more impractical solutions borne of limited or very general expertise, we rely on our team of 75+ carefully selected senior operational healthcare experts to ensure we provide the most relevant and value added experience across the full range of management disciplines and clinical specialties that fall within healthcare services.

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