Summary:

In the ever-expanding realm of technology, there are certain projects that push boundaries, redefine possibilities, and leave long-lasting impacts. Recently, the CEO of our company challenged our team with one of these projects. The task was to follow up on claims with an outstanding amount of as much as $30 Million. Combining vision and strategic alignment, together with meticulous planning and work ethic, our team readily accepted the challenge and was able to turn this project into a colossal success.

Project Goals:

The target for the Project was set to recover 15% of $30 Million using 30 dedicated resources.

Project Timeline:

The project was promising. Our team not only managed to undertake and wrap it up but simultaneously exceeded our target, all within the period of one year.

Challenges and Setbacks:

The initial stages of the project were challenging, due to not only the versatility of the claims but also the diverse nature of the client. To add to its complexity, there were over 200 providers in the group with almost every specialty.

Additionally, the limitations to accessing the portal made it hard for the team to access patient information and claim status. This, in turn, hindered their ability to touch production targets. Moreover, a variety of coding issues were present, requiring defined review and correction by the team. Many claims were denied due to passed timely filing period. In order to solve what could have otherwise been a substantial problem, our team diligently drafted appeals, with all the necessary documentation

along with proofs. Obtaining Medical Records from the client’s office proved to be quite demanding, which slowed the pace of the project.

Project Success:

Fortunately, due to the determination and guidance from our CEO, the precise project planning by our managers, and the diligent efforts and expertise of our team, the AR Recovery project was a success.

Claims with coding issues were reviewed and suggestions were made to the client to tweak their coding; since they were previously not coding their Emergency Room – Hospital and Annual Wellness Visits adequately. The client then agreed to and made the essential alterations, which resulted in extra payments by the insurance companies.

As a result, our team was able to recover more than the anticipated amount.

Learning Outcomes:

In projects like these, constant reporting and communication are key elements. The team learned and executed the plans, finding a way to work efficiently and get the claims paid, avoiding getting overwhelmed by any complexities.

With these valuable insights, the team is now well-prepared and enthusiastic to undertake any Recovery Projects, similar to the one preceding.

Conclusion:

This project stands as a resounding success that showcased our organization’s expertise, professionalism, and the quality of our service. It also demonstrated the team’s ability to learn, adapt to, and flourish in any project, no matter how intimidating. We take pride in our team and their achievements, and look forward to taking on greater tasks like this in the near future.