Case Study- RCM Solutions for Physician Practices

Client Profile

RCM Consulting - Primary Care

SCALE was engaged by a client in the primary care specialty to improve their Revenue Cycle Management (RCM) performance. Through collaboration and data-driven changes, SCALE assessed and made recommendations for policy updates, procedure enhancements, workflow implementation, and the development of industry-standard KPIs. The results included increased accuracy in coding, reduced claim lag time, improved denials management, and decreased outstanding debt.

Client Profile

MSO Integration – IT Systems / Revenue Cycle Management

Overview – Our Client wanted to integrate three separate practices into one single practice and sought SCALE’s multi-disciplinary expertise to achieve this goal.

Key Initiatives

Platform Strategy, Operations and Development

Overview – SCALE was tasked with a ‘blank slate’ mandate for one of its clients. The Company was stable, had no debt and a positive cash balance, was cash flow positive and growing, but was looking for outside guidance on how to further improve its business and operations.

RCM for a Multi-Specialty Practice

Overview – SCALE began working with a multi-specialty practice with approximately forty providers on a host of performance improvement initiatives. The practice decided that it had insufficient leadership and expertise to improve and turn around its billing operation and so it engaged SCALE to provide all RCM services. In a matter of weeks, SCALE took over the billing function and began improving performance.

Client Profile

Coding Performance Oversight – Primary Care

Overview – Our Client consists of one high volume practice with four specialties. The Client is an active participant in government/commercial payer initiatives to deliver value-based care. They had not implemented a robust coding and clinical documentation program and recognized this as a key strategic area for performance improvement..

Client Profile

Post-Close Integration

Overview – Our Client completed a sizable acquisition expanding their footprint in additional states. The Company had not completed a transaction of this size previously and was seeking support to develop a holistic integration strategy across core functional areas. Further, the Company was experiencing specific pain points in its current IT and RCM departments and was seeking guidance on how to address these pain points and how to develop the right integration strategy in the context of these pain points.

Client Profile

Fully Managed Diligence

Overview – Our Client is a highly acquisitive MSO with operations across seven states and seeking to continue its rapid add-on M&A activity across transactions of varying sizes from small solo practice tuck-ins to larger multi-site add-on acquisitions.

Performance Improvement Case Study #1

BACKGROUND & CURRENT STATE – A DSO based in Tennessee with just under 100 clinics in five states approached SCALE Healthcare with cash flow & liquidity issues. The client was growing at a rapid pace and had experienced issues integrating new practices into its existing RCM program. In the past year, RCM deficiencies resulted in lower accrual forecasts and there was a lack of central oversight of their RCM structure.

Client Profile

Revenue Cycle Management – Dermatology

  • Our Client wanted to urgently remove their RCM leader and redeploy associated RCM resources as their internal RCM department was underperforming
  • Our Client’s lack of denial and AR management was resulting in high Days in AR and %AR > 90 days.
  • Remittances were not entered in their system, including expired checks and credit cards never credited, and they had multiple unposted Electronic Remittances with little reconciliation to their bank account.
  • The Client also had a lack of follow up on credentialing causing denials and appointment woes.

Client Profile

RCM Diligence – Infertility

Our infertility platform Client was acquiring multiple regional practices simultaneously and their prior RCM vendor was not providing specific knowledge and insight required to accelerate postclose activity.

Our Client needed a diligence assessment of their target RCM team and processes, which included the need to …..

Client Profile

RCM Consulting – Primary Care

Overview – SCALE was engaged by our Client to improve their overall performance in RCM and:

  • Assess the RCM department’s overall functionality including the skill sets of the team members
  • Assist in interviewing Director and manager of RCM
  • Make recommendations on policy changes/adds
  • Assist in updating RCM procedures and processes

Client Profile

Full-Service Revenue Cycle Management

Our Client’s former outsourced RCM company was underperforming with a lack of denial and AR management resulting in high Days in AR and %AR > 90 days. Over 800 UnitedHealthcare claims were pending medical records review, up to 1 year old.

  • Our Clients’s patient invoicing problems were resulting in overwhelmed office staff and dissatisfied patients.
  • SCALE was engaged to respond to UnitedHealthcare requests as well as review coding to eliminate error rates and prepayment reviews.

Client Profile

Full-Service Revenue Cycle Management

SCALE was engaged to catch up on outstanding remittances to bring accounts up to date, maximize collections on old unworked claims, and provide feedback to practice on individual insurance guidelines to minimize denials and loss, maximize claims throughput in addition to ongoing proper insurance denial and AR action.

  • Our Client wanted to urgently remove their RCM leader and redeploy associated RCM resources as their internal RCM department was underperforming.
  • Our Client’s lack of denial and AR management was resulting in high Days in AR and %AR > 90 days.

Client Profile

DSO Turnaround Assessment

SCALE was engaged by a lender to assess a DSO business that is failing, and provide a recommended course of action to management to support closure, or stabilization & future success.

  • DSO was owned jointly by a PE firm that held the primary equity stake, and lender holding the debt.
  • Management team was in chaotic state and business was losing approximately $1-$1.25mm a month over a 18 month period
  • Lender understandably concerned about future prospects given routine capital calls

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