Case Study: Orthopedics Practice Recovers $4 Million
Large Richmond-area orthopedics practice recovers $4 million in lost workers’ compensation revenue
Situation
Tuckahoe Orthopaedics is a large orthopedics practice in Richmond, Va. For more than 40 years, Tuckahoe’s attentive staff and highly trained physicians have served the local community, treating thousands of people from all walks of life, from children to retirees, 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.
While the practice was highly successful, until recently, it was only receiving an average of 46 percent — and often considerably less — of billed charges on workers’ compensation claims. The reason for the low workers’ compensation reimbursement at Tuckahoe was 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
- Necessary staffing levels to navigate the appeals process successfully
At the time, practice leaders considered a variety of solutions to achieve a higher rate of billed charges on workers’ compensation cases. As a result of this process, Comp Recovery, Inc. (CRI), 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.
Solution
As a leading provider of revenue recovery strategies, CRI took an initial deep dive into Tuckahoe Orthopaedics’ financials to determine why the practice’s workers’ compensation reimbursements were so low. First, the firm identified the causes of low reimbursements in workers’ compensation cases, particularly those involving surgery.
Based on its findings, CRI then determined 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 as well as working through issues that lead to low initial underpayments on current billings.
“It’s hard to imagine what life was like before we started working with Blake and the Comp Recovery, Inc. team,” said Diane Wakefield, Tuckahoe Orthopaedics’ business manager. “They took time to talk to key personnel throughout our practice and to better understand our workflow.”
Results
Today, Tuckahoe Orthopaedics continues to implement CRI’s action plan to manage the complexities of workers’ compensation cases and ensure opportunities are not overlooked or lost. Using CRI guidelines and workflows, workers’compensation cases are now paid consistently, and the overall workers’ compensation reimbursement level at the practice is 85 percent. Its revenue stream also is more controlled, predictable and manageable.
Overall, Tuckahoe Orthopaedics has recovered more than $4 million in previously uncaptured revenue for injury and workers’ compensation claims. There also are no more bottlenecks in the workers’ compensation claims processing workflow.