PRRS: Transforming Revenue Cycle Management for a Complex Healthcare Organization

Background

PRRS was contacted by an organization operating four full continuum of care facilities and a large medical group. They had previously partnered with several billing companies but felt dissatisfied with the results. At the time they reached out to PRRS, they had transitioned to in-house billing, believing they had an effective team in place.

The Challenge

Despite their confidence, the organization faced significant challenges. They were undergoing three payer audits due to various issues, including improper billing and documentation practices. This situation severely impacted their revenue pipeline, resulting in two large recoupment requests totaling over $11 million. Additionally, their accounts receivable (AR) was growing daily, reaching over $10 million in unpaid claims.

PRRS's Solution

Upon being contacted, PRRS conducted a comprehensive evaluation of the factors affecting the organization's revenue cycle. Our team devised a strategic plan to address these issues and implemented the following steps:

1. Transition to PRRS Billing Services: We transitioned all new claims to PRRS, ensuring they were properly billed, which significantly increased incoming revenue.
2. Audit Resolution: We worked closely with the payers to address and satisfy the audits, successfully reducing the recoupment requests to under $900,000.
3. AR Management: PRRS took over ongoing AR management and created a revenue priority plan to resolve all unpaid AR.

The Results

PRRS's intervention led to a remarkable turnaround for the organization:

• Proper billing of all new claims, resulting in increased revenue.
• Reduction of recoupment requests from over $11 million to under $900,000.
• Effective management of AR, putting the organization on a path to financial stability.

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Conclusion

PRRS demonstrated its expertise in revenue cycle management by transforming a complex and financially strained situation into a success story. The organization now enjoys improved revenue flow, resolved audits, and a clear plan for ongoing financial health, thanks to PRRS's comprehensive and effective solutions. Find out how PRRS, Inc. can help you optimize the health of your revenue cycle by call 1-888-405-3118 or visit us on the web at www.prrsinc.com.