Orthopaedics Practice Recovers $4 Million
01. The Client
A large orthopedics practice (the “Provider”) in Richmond, Virginia. For more than 40 years, the Provider’s attentive staff and highly trained physicians have served the local community, treating thousands of people from all walks of life, including children, retirees, athletes from local sports teams, and Olympic stars. The practice offers specialized care in the following areas of orthopedics: foot and ankle; hand and upper extremity; joint replacement; pediatric orthopedics; spine; and arthroscopy and sports medicine.
02. The Сhallenge
While the practice was highly successful, until recently, it was only receiving an average of forty-six percent (46%) — and often considerably less — of billed charges on workers’ compensation claims. The reasons for the Provider’s low workers’ compensation reimbursement were complex, but typically attributable to:
- Incomplete understanding of workers’ compensation payment guidelines
- Low-paying or poorly negotiated PPO contracts
- Repriced bills by silent PPO companies such as FairPay Solutions
- Lack of necessary staffing levels to successfully navigate the appeals process.
At the time, practice leaders considered a variety of solutions to obtain a higher rate of billed charges on workers’ compensation cases. As a result of this process, Comp Recovery, Inc. (“CRI”), which offered a technology-focused solution for optimizing workers’ compensation-related reimbursements and workflows, was selected for its proven track record, exceptional operational performance, and data-driven approach.
03. Solution
As a leading provider of revenue recovery strategies, CRI took an initial deep dive into the Provider’s financials to determine why the practice’s workers’ compensation reimbursements were so low. First, CRI identified the causes of low reimbursements in workers’ compensation cases, particularly those involving surgery.
Based on its findings, CRI then determined that there was a strategic opportunity to appeal specific out-of-network claims that initially received low reimbursements. It then methodically corrected back billings and procured additional payments on closed accounts, and worked through other issues that were leading to low initial underpayments on current billings.
Business Administrator
Virginia Orthopedic Practice04. Results
Today, the Provider continues to implement CRI’s action plan to manage the complexities of workers’ compensation cases. Using CRI’s guidelines and workflow processes, the Provider’s workers’ compensation cases are now paid in a more consistent manner, and the overall workers’ compensation reimbursement level at the practice is 85%. Its revenue stream is now more controlled, predictable and manageable.
Overall, the Provider has recovered more than $4 million in previously uncaptured revenue for injury and workers’ compensation claims. Bottlenecks in the workers’ compensation claims processing workflow have also been eliminated.
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