Speed is the new big

This client partner is a prominent player in the diagnostic and orthopedic 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.

Attack Plan 1

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.

• The matrix involved capturing best-in-breed responses to denials and systemizing them, so responses to a certain denial were consistent and proven.
• The program eliminated claims not due for follow up, and queued claims using an auto-allocation algorithm, with minimal dependence on the supervisor.
• The AR program was now effective, focused, error free and generating revenues at an accelerated pace.
• The client partner could now measure parameters like AR staff productivity by claim type, yield by payer type and touches to closure.

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.