The Power of Comprehensive RCM Services in Kidney Health Specialists's Success Story
Outsourcing medical billing and credentials to **Code Credentia** allowed Kidney Health Specialiststo eliminate critical billing administrative burdens, recover aged claims, and drive substantial growth. Below, we detail the challenge face by the practice and the direct solution delivered by Code Credentia.
The Challenge
Kidney Health Specialists had accumulated an aging Accounts Receivable (A/R) backlog of over $200,000. The primary issues stemmed from the complexity of Medicare ESRD monthly capitation payments (MCP) and bundling outpatient dialysis charges with clinical nephrology encounters, which led to automated insurer rejections.
The Solution
Code Credentia's nephrology billing team conducted a comprehensive audit of all aging claims. We established a clean-claim protocol to verify patient insurance eligibility prior to dialysis visits, implemented automated charge entry validation for ESRD code bundles, and managed persistent follow-ups with commercial payers.
Through the Partnership with Code Credentia, Kidney Health Specialists Achieved Remarkable Results:
- ✓Cleared 94% of the $200,000+ outstanding aging A/R backlog within 60 days.
- ✓Established a clean claim submission rate of 98.5%, minimizing new delays.
- ✓Significantly reduced billing inquiries from patients through simplified statements and upfront eligibility verification.