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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

  • Standardized plans accepted across geographical regions

  • Identified providers not on standard plans

  • Set benchmarks for team to credential all providers within a specific timeframe

  • Created the credentialing score, a metric to measure and track credentialing status by provider

  • Built tools to highlight current status and tracking toward goals

  • Designed and implemented a comprehensive insurance matrix used by a centralized call center for scheduling accuracy

AT A GLANCE

CHALLANGES & RISKS 

  • No Visibility to Current Payer Participation Status

  • No Standardization or Process in the Department

  • No Metrics or Methods to Measure Success

BENEFITS

  • Reduced Non-Par Denials

  • Increased Patient Access

  • Reduced Scheduling Errors

  • Increased Revenue Capture

  • Increased Provider Satisfaction

  • 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.

Founder, THE IMPROVEMENT SPACE

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