ENT and Allergy Associates has more than 300 clinicians practicing in over 55 office locations in New York and New Jersey. The practice sees over 100,000 patients per month.
The Challenge
Like many healthcare organizations, ENT and Allergy Associates experienced the negative effects of COVID-19 starting in 2020. As the pandemic evolved throughout 2021 and 2022, the medical group struggled with staffing shortages not only among providers in their hospitals, but also with front desk staff and office personnel. Their offices ended up taking on additional responsibilities to ensure patient safety.
The team at ENT and Allergy Associates took on the challenge of reviewing their processes to find opportunities to improve their efficiency. Their goal was to not only reduce work for their office operations staff, but also to streamline and automate their billing to achieve clean claims without the need for additional staffing.
ENT and Allergy Associates has over 50 locations. Their doctors are responsible for coding charts, and their office managers review and drop charges for billing. They have a centralized billing team that uses a backend claims scrubber to ensure clean claims.
The Solution: The Revenue Cycle Engine
In early 2022, the billing team at ENT and Allergy Associates worked with the RCxRules team to build specific rules based on individual payer requirements. They were able to integrate these rules before their RCM system resulting in automated claim corrections and a reduction in the number of tasks and time the offices were spending to review charges. Adding RCxRules to their process reduced their office managers’ workload, allowing them more time to attend to patients.
The Results
Prior to implementing the RCxRules Revenue Cycle Engine, manual intervention was needed for all corrections. Since implementing the solution, ENT and Allergy Associates has achieved an 82% automation rate, meaning staff only has to intervene on 18% of billing and coding issues.
“The results of implementing the RCxRules Revenue Cycle Engine have been amazing. Over the first six months we have realized 82% automation of claim rules with no staff intervention.” -Margaret Hargrove, Sr. Director of Revenue Cycle Management at ENT and Allergy Associates
The average time a claim is in the Revenue Cycle Engine is 6-8 hours. This is based on a selective hold period to allow time for corrections with RCxRules. The improved workflow eliminated the labor-intensive charge void and re-enter process in their RCM system. The group has also brought their compliance team into the process to review coding, which allows a streamlined opportunity for them to review, monitor, and further educate physicians when new policies are published by payers. The resulting cleaner AR and fewer corrected claims benefit everyone.
Find out how other large medical groups use RCxRules software to boost efficiency by exploring these success stories.
