This client partner is a prominent player in the diagnostic and orthopaedic segments, in the Midwest region. They were fighting a Fortune 20 company for market share in one segment, and faced pricing pressure from their customer base on the other. This was squeezing margins by 12%, when Quintessence was called in to arrest margin erosion, and then build capabilities to expand the customer base.
Quintessence proposed a full-cycle outsourced solution, whereby full responsibility was taken for reimbursements (collections), backed by a success fee model in the true spirit of partnership.
Quintessence took control of service delivery, by creating specialized teams to handle the various RCM functions: patient data, eligibility, coding, claims, rejection management, ERA, AR, denials and credit balances.
Quintessence wrote interfaces, built process management tools and automated certain functions. The coup de grace was a comprehensive denial matrix-driven AR follow-up tool, that delivered maximum impact.
Once the transition was completed, the client partner reaped the twin benefits of a competitive service delivery program and an approximately 75% variable cost structure in their balance sheet. The client partner was not only able to defend their customer base, but also raised a barrier to the competition, with superior performance.
Quintessence and the customer realized the outsourcing of AR functions and delivering it using our AR Tool (Reimburssence) will have immediate and maximum impact on collections. Quintessence implemented the AR Tool and devised an AR liquidation strategy, based on historical performance of payers on specific procedures and denials.
Accordingly, claims were stratified by payer after which, ‘High Dollar’ and ‘No Status’ were targeted with consistent and proven action steps, that had a precedent of delivered reimbursements in the past.
A mass action plan for certain other types of ‘no response’ claims, resulted in payer responses that led to further corrective action, leading to reimbursement.
As a next step, Quintessence set out to streamline eligibility, hospital interfaces, and denial management. The client partner and Quintessence identified non-revenue yielding processes, and transferred responsibility to the end client.
The resultant impact generated an additional 3% increase in cash net of adjustments, thereby neutralizing the impact of price pressure.