How Orthos increased a practice’s cash collections by 35%+

As we all know, running an RCM team can be difficult and matters are made even worse by having to jump through hoops to meet payer requirements.  To help make your life easier, below is a case study outlining how Orthos can leverage it's purpose built technology to keep more money in your pocket with less headache. 

Background:

At the beginning of 2020, Orthos onboarded an independent Orthopedic practice in the Midwest as a full Managed Services customer.  The client, who had previously insourced their billing, collections and pre-cert functions, had decided it was time for an outsourced partner to lead their RCM department. 

The problem:

This practice had a variety of issues, the most critical being:

• Reduced income and growing A/R balance

• AR days >65 with little understanding of AR days by payer, provider and specialty

• Delays in collections, constant run around with no clear reason why payers were delaying payment

• No visibility into accuracy of payments, team had never undergone an audit and was not reviewing claims beyond their initial collections

• Declining reimbursement rates with no direct reason other than (possibly) payer mix

Setting up Orthos:

Orthos' team onboarded the client by connecting their EMR/PM system, Athena, to the Orbits platform. 

This setup involved Orthos' data experts working alongside the client to access, map and ingest all of the practices data into a proprietary data model.  Although we can do it different ways, in this case it included setting up a SQL server to securely ingest all of the clients data and verifying the file mapped to match the clients current views. 

Upon completion, the client reviewed the Orthos reporting and confirmed that the data matched their internal EMR/PM and was able to trust that Orthos was starting from the right point. 

Setting up Orthos:

With ingestion completed, the Orthos platform used its proprietary algorithms to identify 3 priorities to accelerate payments:

• Release claims stuck in hold

• Accelerate charge capture

• Process change in payment posting

Orthos' solution:

Using a verified data source and powerful machine learning algorithms, Orthos got to work including:

• Using data and analytics insights from our platform to build software for internal use (Orbits Claim Prioritization and Orbits Reporting)

• Worked with practice to redesign 1 clinical process (charge capture) and 1 financial process (payment reconciliation)

• Fully implemented changes into effect by January 2021 with benefits being realized on an ongoing basis today

The combination of powerful tools such as Orbits Claims Prioritization and visibility from Orbits Reporting gave clarity into where the problematic areas existed.  The team quickly discovered that each month the practice was:

• Losing ~$75k to timely filing write offs

• Had no clear order or flow to working claims queues

• Was being charged different rates for different providers while performing the same procedures, at the same facility with the same payer.

With 2-months of implementing Orthos' solution, the practice saw an 8% increase in collections followed by a >39% increase in collections (see graphic above for further detail).

Outcome:

As you can imagine, this windfall of recovered lost revenue was a great surprise for the practice and validated their decision to outsource to an RCM expert.  That quarter resulted in the highest bonuses the providers had ever received (doubling their previous quarter), gave them financial runway to hire 2 new providers and paid spot bonuses to it's staff.  

What's next:

To capitalize on the initial excitement, Orthos has begun developing a mobile access reporting tool for the Doctors to monitor their individual performance and benchmark to their team.  This has resulted in accountability to the organization that previously didn't exist and will lead to even great returns in the future. 

Takeaway and next steps:

If this story resonates with you, rest assured you're not alone.  Orthos can help get your RCM department back on track and reduce the headaches that keep you up at night.  Connect with one of our team members to see a demo of the platform and decide if you're reach to start maximizing your cash collections.

If this story sounds familiar, rest assured you’re not alone and never too far from getting back on track. Connect with an Orthos expert to learn how you can resolve your issues by working with RCM experts today.

#Orthopedics #RevenueCycle #RCM #BillingandCoding #MedicalBilling