Fast-Growing Gastroenterology Practice Transforms RCM Operations

Our client is a large gastroenterology physician group practice with 140+ physicians across two states in the northeast. Their mission is to provide patient-centric care and ensure seamless coordination throughout every step of a patient’s journey.

A Fast Growing Business:

The client is quickly growing and expects to continue experiencing accelerated growth, and is looking to adopt technological solutions that can help scale its operations effectively.

A Large Payer Mix:

The client is contracted with a large payer mix and recognizes the need to quickly pivot and make data-driven decisions to stay ahead in the ever-evolving industry.

A Large and Distributed Team:

Located across states, its 140+ physicians perform over 700,000 patient encounters per year. Their RCM team consisted of both onshore and offshore team members.

The Challenge

One of the primary challenges the RCM team faced was consistently being a step behind in tracking and resolving denials. This was in part due to the fact that
the reporting offered by their EHR - athenahealth - lacked granularity into denial code reasons, as well as the ability for users to view performance across different payers and locations. The client was constantly acquiring new practices that had their own RCM workflows and disparate sources of data. The VP of RCM oversees a large team and recognized the need to streamline processes to prepare for the continued accelerating growth of the business, and apply technology to contain their staffing spend over time relative to their claim ratio.

TLDR:

• Reactive issue identification and denials management disrupts cash flow.
• Labor-intensive data analysis across disparate systems and datasets.
• Keeping up with rapid business growth and control staffing costs as their claim volume increases.

The Solution

In order to stay ahead of claim denials and increase revenue per claim, the client searched for a solution that could integrate all of its existing and new practices into a unified RCM workflow. Adonis engaged in conversations with the clientʼs Chief Operating Officer COO) and VP of RCM, and other members of their team, showcasing the ways in which the Adonis Intelligence platform can help unify their data sources preemptively alert their teams to changes to payer rules and other factors that can lead to claim denials or delayed reimbursement. This would equip their teams with the knowledge and the tools to proactively safeguard their hard-earned revenue.
Adonis successfully launched with the client within a matter of weeks, including integration with their system of record, athenahealth, and held training sessions to familiarize the clientʼs team with the new platform. Adonis continues to hold regular meetings with the client to identify new use cases and gather feedback to continually improve the productʼs alignment with the client's workflow.

TLDR:

• Use Alerts to spot payer denial trends early and get ahead of them before they became a sizeable issue.
• Leverage out-of-the-box dashboards and reports, eliminating the need to manually consolidate reports via spreadsheets.
• Free up employee bandwidth and repurpose their day-to-day to support projects that significantly benefit from human intervention.

They Achieved

The client ultimately achieved a 4.5x ROI

• ~30 day reduction in days to cash
• 10% lift in collections on alerted claims
• 1% lift in underpaid claims

“As we've rapidly grown the number of providers and payers we serve in multiple markets, the team and Intelligence platform at Adonis provides us with a unique,
differentiated set of insights and alerts across numerous RCM functional areas, allowing us to quickly respond to the evolving payer dynamics and enhancing our overall revenue integrity in a scalable fashion.”

– Chief Financial Officer

‍