Client: Women’s and Family Health Practice
Location: Ohio, USA
Industry: Healthcare – Medical Billing and Credentialing
Key Focus: Ultrasound Documentation, Medical Coding Accuracy, Revenue Optimization
Client Background
Incomplete and missed documentation of the ultrasound images when performed on the bedside was not tracked by the provider group for many pregnant individuals.
Our internal audit was for an Ohio-based Women’s and Family Health practice which was operating in 3 locations with 16 providers in the group.
Challenges in Ultrasound Documentation and OB Billing Reimbursement
Medical Billing Wholesalers team of revenue cycle practitioners and managers analysed the issue and determined that the following challenges were leading to reduced reimbursement:
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Incomplete and missed documentation of ultrasound when performed
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Missing to document the conditions or situations which led to US performance
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Diagnosis codes which are not to their highest specificity
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Filing of the ultrasound procedure codes individually provoked more of rejections and denials
Solution
When the practice outsourced the processes to Medical Billing Wholesalers, we developed a comprehensive revenue cycle transformation plan. Our objective was to bring about holistic improvement by addressing all the issues with the current state and help the practice grow. Our team of billers and coders executed the following solutions:
1. Medical Records Audit
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Reviewing Medical Records to check whether it supports high-level coding
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Keeping the claims on hold if the MR is not complete and when it does not have the ultrasound images updated on the PAS
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Discussed the importance of scanning the detailed medical reports to arrive at the more specific diagnosis and code for all the services which were provided during the same encounter
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Provider education inputs was given to the provider group on the commonly performed not inclusive services to the global OB package and explained them the importance or requirements on documenting the image details for sooner filing and reimbursement.
2. Claims Tracking
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Analyzing physician wise trends, to make sure that we are sharing the details with the provider on the claims which are pending for additional details
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Keeping the claims on hold until the provider provides the ultrasound Images and the specific diagnosis to avoid denials and unnecessary follow-up
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Insights regarding the issues prevailing in medical records were shared with the providers as and when required to avoid recurrence and to improve the clean claim ratio
Result
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The documentation process was streamlined completely and the number of accounts pending for image documentation was reduced to 5% in Dec ‘24 which was 21% in Mar ’24
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Issues related to Medical records were brought under control, clean claim ratio has improved
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The average monthly collection was increased from $176,000 to $209,500
Results Summary
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Pending Ultrasound Documentation Accounts: Reduced from 21% to 5%
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Average Monthly Collections: Increased from $176,000 to $209,500
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Clean Claim Ratio: Improved through provider education and tracking