CASE STUDY:

Establishing a Revenue Cycle Management Team

Scale Physician Group discovered significant gaps in our Client’s billing department through our initial audit. Our Client had several KPIs that were below target benchmarks such as denial and rejection rates, they received a high number of patient complaints with regards to billing, and many of their providers were not properly credentialed with key plans. The net result was a highly busy practice with negative cashflow, on account of not collecting on all potential revenue and letting a significant amount of claims age.

Scale Physician Group’s billing team took over our Client’s revenue cycle management operation.
Initial efforts were directed at re-submitting aged claims that had been billed incorrectly and were at risk of lapsing beyond the timely filing deadline.
A credentialing employee was brought in to audit the providers, add them to important plans as needed, and develop a tracker and template for in-house maintenance.
Our billing team began re-submitting incorrect claims and implementing a new work flow to ensure that verification was happening in all cases, that claims were being submitted correctly, and that billing queries were being addressed in a timely manner.
Our team identified numerous services for which the business wasn’t charging (counselling, screening, vaccination, chronic management) and added the appropriate codes.

Our Team

Roy Bejarano is the Co-Founder and CEO of Scale Physician Group.

Prior to SPG, Roy served as Physicians Endoscopy’s Chief Strategy Officer & Co-President of Physicians Endoscopy’s PE Gastro MSO initiative.

Jason Schifman is the Co-Founder and President of Scale Physician Group.

Prior to SPG, Jason most recently served as Physicians Endoscopy’s Executive Vice President of Strategy across the Company’s ASC and PE Gastro MSO platforms.

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