Turning Chaos Into Cash: NYX's Success With DME Billing in North Carolina

Business Challenges

The client was looking for an outsourcing partner who could provide important research data on reimbursements and billing of DME products. They wanted to partner with a professional service provider who could provide the services at a very competitive price and within a quick turnaround time. Although similar to many other projects we have completed, the main challenge of the project was that the client wanted us to perform in-depth research for various DME products, DME billing processes, insurance coverage, and update spread sheets accordingly under 6 FTE for 21 different branches.

Setup:

• Total Accounts Receivables- $ 1 million plus
• Insurance Accounts Receivables – $ 700K of the total AR. 90+ AR % was close to 85%
• Patients Accounts Receivables – $ 250K
• Collections – $ 120K
• AR days was 90 days.
• No denials were worked promptly & there was no proper documentation on denials
• Patients Accounts receivables were totally a mess and no patient’s statements were generated in the proper duration.
• No proper follow-ups were initiated on the claims
• More than 150K charges were unbilled
• Billing was skipped for many of branches
• Claims were processed out of network
• Authorization were not taken on many of claims
• EFT set was not done
• Network participation was not initiated with majority of insurance
• Majority of payers were getting claims via paper.

Appropriate steps for streamlining Billing

• Share drive created and login shared with all the branches so that no documentation or billing get skipped
• EFT set up initiated with majority of payers
• Credentialing and network participation is done with majority of payer
• Benefit and authorization was done before delivery of products
• Procedure and payable DX list were shared with all the branches
• If required revised CMN were requested to avoid denials
• Bi-weekly training were provided by NYX to all field rep to educate them more on billing side
• Electronic submission were initiated to reduce cost of paper billing and turnaround time

Appropriate steps handled to reduce the AR:

• Teleconferenced with the client to get a clear insight on how the they worked.
• Charge errors were reviewed and billing rules put forth in order for the office to correct their mistakes. The charge errors were mainly due to the inappropriate usage of modifiers, procedure codes etc. So, appropriate coding rules were also formulated.
• Some charges were not filed to the insurance carriers at all, due to some technical snag in the system, which were identified and rectified.
• Electronic Submissions and retrieval of rejected reasons were analyzed in detail and % of rejections was reduced by making the client aware of the mistakes.
• Patient’s statement schedules formulated and started the process of generating patient statements at regular intervals. At times, all the four bill cycles were audited and generated to avoid increase in AR.
• Patient AR policies were designed to suit the best of this practice.
• The claims that have lesser timely filing limit were identified, their denials analyzed and appropriate appeals handled with the medical records.
• Patient’s co-insurances/deductibles were allocated incorrectly and these were identified and rectified.
• Outdated diagnosis codes kept generating by the system in default, which was identified and fixed with the help of the software team.
• Frequent error reports, missing ticket reports, future appointment cases mailed to client to have a clear track on their office activities, patients flow and missing charges.

Key Achievements

• Current Total AR – $ 500K
• Current Insurance AR – $ 300K
• Current patients AR – less than $50K
• Collections – $200 K – $230K
• Highest collections recorded in this account since NYX started handling the account was $247K – 5 months.

Customer Testimonials

• “After 20 years in DME business, I got visibility on my business, result can be seen in my bank credits, Bi-weekly training to field rep and managed pre-billing activities are awesome, I would recommend NYX.”
• “Thank You NYX we have added 3 new large braches and they are pleased with their collection and your prompt response on anything they are looking for.”