CASE STUDY

Full-Service RCM Solutions

Overview

SCALE RCM successfully took over RCM for a multi-specialty practice with minimal disruption and improved performance

  • SCALE RCM began working with a multi-specialty practice with ~40 providers (across Nephrology, Cardiology, and Primary Care)
  • SCALE RCM initially worked with the practice on several initiatives, including moving to a single EMR/PM, reducing days to bill, triaging unbilled encounters, and tracking aged receivables
  • After completing these initiatives, the practice’s management team concluded it had insufficient leadership and expertise to improve its RCM department, so management engaged SCALE RCM to provide full RCM services
  • Once SCALE RCM took over the RCM department began showing improvements
  • After seven months SCALE RCM improved billing efficiency by ~70% based on key performance metrics (Days to Bill, Days to Pay, and Unfulfilled Encounters)
  • In addition to improving the collection cycle, SCALE RCM’s process improved coordination with the internal operations team
  • SCALE RCM continues to manage the practices billing, as well as identifies areas for improvement
SCALE RCM brings decades of experience building and managing revenue cycle operations of scale.  We have developed and refined best practice systems and processes through billing across more than 30 medical specialties as well as numerous sites-of-service and practice management & EHR systems.

Implementation Timeline

SCALE RCM Worked with Client on Rapid and Smooth Transition of Billing Services

  • Within six weeks SCALE RCM was billing out all claims on a new practice management software, which was already part of the practice’s EMR
    • RCM team bill out time reduced to under one day
    • Reduced provider chart close-out timing to under five days
    • Assisted practice in reporting and managing unclosed charts
  • Subsequent transition, SCALE RCM  worked down old A/R on old billing platform, including months of significant A/R
  • Staged transition so that some services, such as eligibility, were taken over once billing flow had been normalized

SCALE RCM’s Impact

KPI Dashboard Shows Impact of SCALE RCM’s Involvement

  • Key metrics for billing performance improved dramatically several months into the engagement
  • SCALE RCM improved the clients billing efficiency, reducing the days to bill and days to pay by ~70%
  • SCALE RCM improved the collections on outstanding A/R older than 90 days
  • Additionally, SCALE RCM continues to improve denial avoidance and management, including implementing customized rules engines and providing provider feedback and training

SCALE RCM Offers a Broad Range of RCM Solutions

SCALE RCM continues to work on refining billing operations, as well as finding areas for additional improvement

  • In addition to improving the practice’s revenue cycle management, SCALE RCM identified areas of improvement and has been working with the practice to implement these changes
    • Improved eligibility and benefit verification
    • Direct assistance with clinical staff to ensure all authorizations and referrals are obtained
    • Improved patient collections and satisfaction with U.S.-based representatives
    • Assisted implementation of patient portal for invoicing and payments
    • Designed workflows to collect estimated portion of payments that are the patients’ responsibility before the time of service