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Case Study
Revenue Cycle Management Services Improves Collections, Strengthens Compliance, and Enhances Reporting
“Anytime you fundamentally change your billing operations, there is trepidation. We were able to retain control of our destiny while enjoying financial improvements virtually across the board. The results far exceeded our expectations.”
- Klonie Berend, M.D.
President
Radiology Associates of Wichita Falls
Customer
Radiology Associates of Wichita Falls
Wichita Falls, Texas
Challenge
Streamline claims process to improve collections, decrease A/R, and strengthen compliance
Products
Change Healthcare documentation assistance, coding, billing, claims management, denial management, business analytics, and physician credentialing
Results
- Self-Pay Collections increased 6%
- Days in A/R reduced 42%
- Charge lag reduced 82%
- Reporting helped support a substantial hospital stipend
- PQRS compliance
The Customer:
Like many radiology practices, Radiology Associates of Wichita Falls (Radiology Associates) has grappled with rising costs, increased regulatory complexity, and declining reimbursements in recent years. Although the Texas group understood that outsourcing its long-time internal billing operations could help ease some operational concerns, leaders were reluctant to surrender billing control to a third party.
But when it became clear that the costs associated with bringing an aging billing platform into compliance with ICD-10 would be enormously expensive, the practice made the decision to align with Change Healthcare.
Today, Change Healthcare provides Radiology Associates with a full range of revenue cycle management services, including documentation assistance, coding, billing, claims management, denial management, business analytics, and physician credentialing.
With the help of Change Healthcare, the practice has mastered ICD-10 while improving collections, reducing compliance risk, and minimizing bad debt. In addition to lower billing overhead, the practice has benefited from a broad range of business intelligence reporting. The group’s coding and billing is handled through the Change Healthcare Radiology Center of Excellence in Greenville, Texas.“
Anytime you fundamentally change your billing operations, there is trepidation,” said Klonie Berend, M.D., president of Radiology. “We were able to retain control of our destiny while enjoying financial improvements virtually across the board. The results far exceeded our expectations.”
The Challenge: Transform Revenue Cycle Operations to Improve Collections, Strengthen Compliance
Radiology Associates is an 8-physician practice that serves United Regional Hospital in the North Texas city of Wichita Falls, population 104,900. The group is responsible for about 150,000 procedures annually. In early 2015, the practice began exploring options for addressing the impending ICD-10 coding transition. Unfortunately, achieving compliance with its aging legacy billing and practice management system would have required multiple and costly software upgrades. As a result, Radiology Associates decided to look at revenue cycle options. In addition to meeting ICD-10 requirements, the group sought to improve collections and strengthen compliance.
The Solution: Implement Revenue Management Solution To Streamline the Exchange of Demographic and Claims Information
As part of its proposal process, Change Healthcare experts conducted a comprehensive audit of the group’s existing revenue cycle operations. The results indicated that the group’s cost of billing exceeded industry norms. At the same time, cash collections were lagging and compliance vulnerabilities were apparent.
Radiology Associates contracted with Change Healthcare to help address issues identified through the audit. The Change Healthcare implementation team immediately established electronic interfaces between the practice and hospital to help eliminate paper and streamline the exchange of demographic and claims information. Documentation education was conducted to better prepare physicians for ICD- 10, and compliance policies were implemented to help reduce regulatory exposure.
The Results: Smooth Coding Shift with Increased Collections, Lowered A/R, and Meet Quality Reporting Requirements
Change Healthcare certified coders based at the Greenville Center of Radiology Excellence took responsibility for coding, claims management and denial management, and within six months, collections had increased by 6%. At the same time, Days in A/R fell 42%. Significantly, charge lag, or the time between when a clinician completes clinical documentation and when the claim goes out the door, tumbled by 82%.
Thanks to the documentation assistance Change Healthcare provided physicians in the months and weeks leading up to ICD-10 transition, the coding shift went smoothly. Additionally, Change Healthcare helped the group meet the mandatory quality reporting requirements associated with the Centers for Medicare & Medicaid Services’ Physician Quality Reporting System (PQRS).
Change Healthcare analytics also produced another significant financial improvement for the practice. Using claims data, the group was able to measure relative value units (RVUs) per physician for the first time. The metrics indicated that each doctor in the group was actually producing nearly twice as many RVUs per month as the typical radiologist in Texas.
Change Healthcare personnel and practice leadership presented this information to the hospital and as a result, the hospital granted the group a substantial stipend that supported the hiring of two additional physicians.
“In today’s turbulent and uncertain reimbursement market, it is difficult to plan for the future if you don’t have a clear understanding of where you stand currently,” Berend said. “Analytics and reports from Change Healthcare have given us enormous new insight into our operations and helped us lay out a strategy for future growth.”
Berend added that a close working relationship with their Change Healthcare client manager not only facilitated a smooth billing transition and rapid ramp-up, but also eased any lingering fears about a loss of control.
