Challenge

Like so many expanding healthcare provider organizations, a mid-sized upper Midwestern gastroenterology practice faced a series of challenges dealing effectively with its growing revenue cycle management (RCM) needs. The practice, begun with a single physician more than 40 years ago, by today has dramatically expanded its scope of comprehensive gastroenterology services, delivered by a dozen physicians, nearly as many nurse practitioners, and an administrative team. 

With ever-changing requirements for coding, prior authorization, denials management, collections, timely A/R follow-up and more, on-site staff and an aging A/R system and processes were insufficient to the practice’s commitment to support delivery of high-quality, cost-effective healthcare services. 

It’s not a rare situation. In fact, one industry survey found that 63% of respondents reported they were experiencing staffing shortages in their revenue cycle departments, which typically lead to lost revenue or delays in the revenue stream due to billing/coding errors, denials and insufficient follow-up.

“When most people talk about healthcare worker shortages, they usually focus on physicians, nurses and other care providers,” said the practice’s CEO. “But if we don’t also run the ‘business side’ of our practice efficiently, we’re failing our patients and our clinicians. In 2024, we determined it was time to make a major change to keep up with demands.”

Solution

The gastro practice found its answer with Advantum Health, a recognized leader in comprehensive, technology-enabled revenue cycle services, combined with a professional team that has a proven track record of delivering results which speed and maximize appropriate reimbursements as the industry and its clients continue to evolve.

The practice is utilizing virtually the full slate of Advantum Health solutions, including:

• Pre-registration
• Prior Authorization (infusions, ambulatory surgery center, hospitals and research)
• Coding & Charges Posting
• Payments Posting
• A/R Follow-up
• Denials Management
• Patient Statements & Collections
• Patient Help Desk (call center)
• Pre-collection (infusions)
• Provider Enrollment (payers/insurances) and Hospital Privileging
• General Consulting (payer contracts)

Education on best practices — “We also were looking for a partner well-versed in the latest RCM best practices for billing, coding and documentation, all of which impact payment delays or denials and which are constantly changing,” the CEO noted. “Our on-site staff are really benefitting from the education support of the Advantum Health team.”