Case Study:
Transforming Revenue Loss into a Department Recognized for Efficiency & Achievement
THE OPPORTUNITY
A large multi-office medical practice was experiencing revenue loss, patient complaints, low provider utilization, and provider turnover due to internal payer credentialing errors and denials.
THE ASK
Uncover issues leading to non-par denials, develop stronger tools for scheduling accuracy, ensure providers are added to standard plans to increase patient access, and reduce denials.
THE PROCESS
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Standardized plans accepted across geographical regions
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Identified providers not on standard plans
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Set benchmarks for team to credential all providers within a specific timeframe
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Created the credentialing score, a metric to measure and track credentialing status by provider
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Built tools to highlight current status and tracking toward goals
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Designed and implemented a comprehensive insurance matrix used by a centralized call center for scheduling accuracy
AT A GLANCE
CHALLANGES & RISKS
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No Visibility to Current Payer Participation Status
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No Standardization or Process in the Department
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No Metrics or Methods to Measure Success
BENEFITS
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Reduced Non-Par Denials
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Increased Patient Access
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Reduced Scheduling Errors
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Increased Revenue Capture
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Increased Provider Satisfaction
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Met Quarterly Goals
THE OUTCOME
In six months, the number of providers fully credentialed on all plans rose from 28% (133) to 89% (419) and to 98% (465) in twelve months.
9x increase in patient visits in week one of employment compared to those one year prior.
The department has a portfolio of tools to streamline work. The business leaders have real-time visibility of credentialing status for 400+ providers.
KELLY POOLE BSN, RN
The Improvement Space was created to help fellow healthcare leaders achieve success for employees, providers, and patients through process improvement, efficiency and scale.