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Orthopedic Case Study: National Medical’s Revenue Cycle Recommendations Helped Unlock an Ambulatory Surgery Center’s Key RCM Metrics and Full Revenue Potential

Orthopedic Case Study: National Medical’s Revenue Cycle Recommendations Helped Unlock an Ambulatory Surgery Center’s Key RCM Metrics and Full Revenue Potential

In 2016, National Medical partnered with an Ambulatory Surgery Center (ASC) in South Carolina after a revenue cycle audit confirmed the in-house billing and facility management were delivering financial underperformance and lacking key Revenue Cycle Management (RCM) metrics.

The ASC sought out National Medical, an award-winning leader in revenue cycle management and compliance in the surgery market, to consult on transitioning total joint procedures to the outpatient setting.

Position Prior to National Medical Partnership

  • Revenue growth had been stagnant for years.
  • The surgery center’s in-house billing process was missing key resources to monitor compliance updates and track progress to maximize reimbursement.
  • The ASC’s board prioritized Key Performance Indicators (KPIs) in financial, operational, patent satisfaction, and employee engagement areas to recruit top orthopedic surgeons to offer expert techniques for total joint replacement surgeries; however, they quickly realized they needed expert revenue cycle advice on medical billing and coding for total joint procedures, as well as managed care contracting and compliance to achieve comprehensive financial success.

Solutions Identified and Implemented by National Medical

  • National Medical guided the surgery center through the step-by-step process of adding total joint procedures, as well as the healthcare reimbursement process. All existing contracts with payers were evaluated to avoid any compliance concerns.
  • As National Medical facilitated the managed care contracting process, comprehensive charge master and case analyses were conducted to optimize reimbursement and to address billing concerns such as overcharging or undercharging.
  • After local competitors’ contractual rates were benchmarked and all insurance and provider contracts were reviewed, National Medical renegotiated exiting contract terms until the surgery center reached market or above market rates, thereby fully maximizing reimbursement.
  • The revenue cycle management provided by National Medical included the monitoring of key revenue cycle metrics, which significantly decreased the surgery center’s rejections, denials, and unpaid balances. National Medical’s ASC billing expertise ensured accurate coding and claim submission.
  • As coding compliance and the ASC’s clean claim rate increased, timely payments increased, which minimized any interruption to the revenue cycle, even as the costs associated with higher case volumes and more complex surgeries such as total joint procedures increased.
  • National Medical’s revenue cycle recommendations granted the surgery center the ability to provide their patients with proficient price transparency.

Delivered Results

  • A recent snapshot of the surgery center’s RCM results include:
    • Days to bill: 2.05
    • Clean claim rate: 98%
    • Cash-per-case on total joint procedures: $19,180
    • Cash-per-case on other surgical procedures: $4,272
  • The surgery center experienced a 180 percent growth in overall case volume from 2015 to 2021, and a 166 percent growth in the cash-per-case.
  • In 2021, the surgery center generated $20mm in revenue, which is nearly double 2019’s revenue of $10.4mm, and 3.5 times its 2018 revenue.

What makes National Medical so successful?

National Medical Billing Services has the highest client satisfaction rates in the industry. It has become the largest, the fastest growing, and the premier surgical revenue cycle company, with clients in over 45 states, for one single reason: our people. Simply put, our people are our greatest asset. We select people with strong intellect, sharp analytical minds, intense dedication and an undying passion for client service. We then unite these characteristics with extensive training in the areas of coding, accounts receivable management, managed care contracting, analytics and compliance.

 

Get the full Orthopedic Case Study here


This post was first published May 31, 2022 and was updated October 24, 2022.



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