Accurate Diagnostic Coding Prevents Denied Claims

After 15 years as part of an independent hospitalist group in Milwaukee, WI, Dr. Alok Goyal and Dr. Pandey Krishna were in transition. They ended their contract with St. Joseph’s Regional Medical Center and formed Milwaukee Internal Medicine Associates (MIMA) to serve patients in both clinical and hospital settings. Doctors Goyal and Krishna brought in the certified coders of ebix to assist them through this transition, minimizing denied claims from insurance companies, maximizing revenue and ensuring consistent cash flow.

HERE’S THE STORY
The first step in increasing MIMA’s revenue was to ensure that their services were priced appropriately.

The ebix team analyzed MIMA’s fee structure by comparing it to both competition and Medicare guidelines to gauge market sensitivity and appropriate reimbursement levels.  During this process, ebix also provided MIMA with industry averages and recommendations; allowing them to make their own informed decisions about pricing.

ACCURATE DIAGNOSTIC CODING PREVENTS DENIED CLAIMS

With ebix’s experienced certified professional coders (CPC) performed a comprehensive review of the CPTs (Current Procedural Terminology codes) using CCI (Correct Coding Initiative) edits, to ensure codes were not bundled and that no modifiers were missing. This enabled ebix to prevent MIMA from realizing too many denied claims due to inaccurate coding.

IMPACT – FUTURE GROWTH ENSURED

  1. ebix supported MIMA as they grew during their first year, utilizing their expertise to drive revenue and create results.
  2. Over a three-year period, MIMA increased their annual charges by 55%.
  3. Over that same period MIMA’s receipts increased by 60%.
  4. The doctors identified other hospitals that would benefit from their services and contracted with them.

 

Extended Reading List:

Real Story Minimizing Denials Delivers Future Growth PDF

Revenue Cycle Management

Benefits of Choosing a Medical Coding Service

Minimize Medical Claim Denials