Recovered Revenue with Machine Learning

CASE STUDY

CLIENT: Crisp Regional Hospital (Cordele, Georgia)

CLIENT INFORMATION: Crisp Regional Health Services oversees the award-winning, high-tech Crisp Regional Hospital with a level 3 trauma center. Its comprehensive network of health and social service facilities includes a home health program, 143-bed nursing home, retirement home, hospice and home care program, dialysis facility, and rural health clinics in bordering areas. More than 50 physicians practice within Crisp Regional Hospital, providing hospital and outpatient care in family medicine, obstetrics/gynecology, emergency medicine, and 20-plus other specialties and subspecialties.

OPPORTUNITY: As a longstanding client of Quadax, Crisp Regional Hospital aimed to explore opportunities for avoiding denials within their revenue cycle. Having achieved significant success with Quadax’s existing solutions, Crisp expressed interest in further reducing their denial rates by targeting specific error categories. Quadax partnered with Crisp to implement Predictive Intelligence by Quadax (PIQ), with the goal of having the ability to predict coding errors and non-covered errors before claim submission to payers, thereby reducing manual workload and delivering substantial ROI.

Predictive Intelligence by Quadax (PIQ) is a powerful predictive model, built with machine learning technology, to transform denial management into denial avoidance, helping you to get paid as quickly as possible. By combining claims and remittance processing with machine learning tools, Quadax built the industry’s most powerful predictive model for revenue cycle optimization.

SOLUTION: While exploring Crisp’s denial avoidance opportunities, Quadax discovered the largest opportunity existed in their coding and non-covered error codes. While building the PIQ model designed specifically to the client, Quadax discovered a trend within their data and established an XpressBiller rule to flag these claims within their Denial Prediction workflow. By setting this new rule, Crisp was able to adjust their previously denied claims and correct them, resulting in a recovery of more than $93,000 which had previously been written off.

By leveraging automated rules within PIQ, Crisp’s claims were halted and predicted edits were remedied before the claim was released, resulting in a reduction in manual labor from encounter to claim release due to limited touches by staff.

ACHIEVING SUCCESS: Predictive Intelligence by Quadax transforms denials into recovered revenue for Crisp Regional Hospital

Utilizing PIQ as an invaluable training resource, Crisp was able to use the predictions from PIQ to aide in remediating claims, allowing their new users to see cause and effect in real time.

By integrating PIQ within Quadax’s claims management solution, Crisp Regional Hospital is able to reap the benefits of the most powerful predictive model for revenue cycle optimization, providing them with the ability to predict errors before they are released. This integration has “proven there is ROI.”



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Samaritan Medical Center Achieves 12% Boost in Cash Collection

CASE STUDY

CLIENT: Samaritan Medical Center (Watertown, New York)

CLIENT INFORMATION: Samaritan Medical Center is a not-for-profit community medical center, offering a full spectrum of inpatient and outpatient healthcare services. From primary and emergency care to highly specialized medical and surgical services, such as cancer treatment, neonatal intensive care, behavioral health and addiction services, and imaging services, Samaritan Medical Center and its team of healthcare professionals proudly serves the medical needs of our civilian and military community. Quality, compassion, and safety are basic principles by which exceptional care is delivered at Samaritan.

OPPORTUNITY: Samaritan Medical Center faced challenges in their revenue cycle billing operations as they operated without a clearinghouse. As a result, the organization had to rely on sending claims through four different methods. These methods included direct submission to Medicare, Medicaid, Blue Cross/Blue Shield, and commercial insurance providers –  notably, without a claim scrubber in the process.

The Samaritan team evaluated multiple clearinghouse providers and ultimately selected Quadax. They were particularly impressed with Quadax’s Xpeditor™ claims management technology which includes Decision Intelligence. According to Chris Hochgraf, Director of Revenue Cycle at Samaritan Medical Center, the Decision Intelligence tool’s ability to analyze trends and provide in-depth insights was the deciding factor. She stated, “Quadax stood out because their data goes beyond individual pieces of information and offers a comprehensive view. It allows us to identify areas for improvement and chart a path to increase our reimbursement.”

Decision Intelligence (DI) by Quadax incorporates tools, technologies, and strategies that help turn raw and disorganized data into purposeful information.  DI helps healthcare organizations acquire meaningful information with real-time insights to efficiently understand complex revenue cycle data and be alerted to key events, trends, customer behaviors, correlations, and patterns for informed decision-making. Leveraging actionable data allows organizations to quickly uncover solutions and achieve improved business outcomes, be more effective and efficient, and positively impact reimbursement.

ACHIEVING SUCCESS: Samaritan Medical Center Achieves Quicker Reimbursements and Time Savings with Xpeditor and the Quadax Clearinghouse

Today… Samaritan Medical Center is experiencing faster reimbursements and saving time after implementing Xpeditor and the Quadax Clearinghouse. Hochgraf stated, “During a challenging period when we faced staff shortages, Quadax helped us take a proactive approach, mitigating issues at the start of the revenue cycle. This has resulted in reduced reimbursement turnaround time and improved cash flow.”

  • Xpeditor’s claim edits and other management tools enable Samaritan Medical Center to send cleaner claims, leading to fewer rejections and denials giving Samaritan a 12% boost in cash collection and a 12% reduction in accounts receivable from January to July 2023.
  • Xpeditor and Decision Intelligence reports offer Samaritan Medical Center visibility previously unattainable, facilitating a more proactive approach to managing the revenue cycle and providing a road map of improvement for their organization.
  • Samaritan Medical Center is maximizing the benefits of Xpeditor technology and is currently in the process of setting up an Automated Secondary Process (ASP). In the past, without a Clearinghouse, their billers struggled to find the time for secondary claims and wrote off substantial amounts of money. However, Samaritan is eagerly anticipating going live with ASP, having the primary claim sent out seamlessly, the corresponding 835 received, and then automatically linked to it to create the secondary claim—eliminating the need for human intervention. This advancement is expected to significantly increase reimbursement for the organization and save even more staff time.

Words of Wisdom from Client: “To those embarking on a similar journey, I cannot stress enough the importance of involving all the stakeholders in the implementation process. The more people you can include, such as billers, coders, and all members of the revenue cycle team, the better the alignment and collaboration you will have when you go live. It was Quadax’s exceptional customer service team that truly turned things around for us. Their unwavering support enabled us to make informed decisions based on best practices, meticulously guiding us through each step of the process. They helped us identify opportunities at the back end, addressing root causes and resolving issues. Quadax went above and beyond their contractual obligations, investing a significant amount of time and effort to deliver a superior level of service for our success.”