Emergency Medicine Provider Boosts Financial Outcomes

Meet the Client

Our client is one of the largest physician-led practice groups, specializing in emergency medicine, hospital medicine, and urgent care. Their mission is to deliver high-quality, efficient healthcare services while cultivating a supportive environment for their medical professionals.

A Diverse Workforce:

Located in 16 states and across 130+ hospitals, its 2,500+ providers perform over 3 million patient encounters per year. Their RCM team consisted of both onshore and offshore team members.

Streamlined Operations:

Recognized for their expertise in staffing and facility management, they focus on maintaining streamlined operations to ensure the highest standards of patient care.

Investment in Technology:

Adopting new technologies has always been one of their key strategies in improving operational efficiency and patient care.

The Challenge

Emergency Medicine providers inherently face numerous front- and back-end revenue cycle challenges due to the diverse range of patients' insurance coverage, the variety
of services provided, and the multitude of payers involved.

To stay ahead in an industry that is constantly evolving and in which payers are constantly changing their behavior, the client recognized the need to be able to pivot quickly and make data-driven decisions. While the client knew they were facing revenue cycle challenges, they were unable to quantify the financial impact of these problems and identify the areas with the most significant opportunities for improvement. Further, they faced a significant volume of denied claims but struggled to identify which claim denials were avoidable, impeding their ability to reduce the backlog of workflows that demanded attention from their A/R team.

The Solution

The client has always maintained a lean staffing model and empowers its teams to operate efficiently by leveraging technology. Therefore, they were interested in a solution that would enable them to get ahead of denial trends, understand the root causes, and make the necessary adjustments to mitigate further denials.

After several conversations with the clientʼs Chief Operating Officer COO) and VP of RCM, Adonis presented the client with comprehensive analysis of their revenue cycle
performance. This analysis helped build rapport and trust with the client, quantifying their major revenue cycle challenges and highlighting and their most significant opportunities for process improvements, allowing them to finally gain visibility into areas that they otherwise would continue to overlook.

Adonis successfully launched with the client within a matter of weeks and conducted in-person kick-off and training sessions. Adonis continues to hold regular meetings with the client to share best practices for product usage and gather feedback to enhance the productʼs alignment with the client's use cases.

Adonis Intelligence enabled the clientʼs teams to:

• Leverage Alerts to spot payer denial trends early and get ahead of them before they became a sizeable issue.
• Remove the need for labor-intensive analysis of kick codes by categorizing them into standard, easy-to-understand denial categories.
• Act on data-informed insights and prioritize the highest value opportunities when it came to denials and A/R management.
• Detect true underpayments and action on them in a timely manner to shorten appeals timelines.
• View real-time KPIs, such as A/R, denials, productivity, and more via Dashboards and Reports without having to export and manipulate the data within spreadsheets.
• Slice the data based on service-level items (beyond just claim-level).

“It is allowing us to identify issues before they become monstrous. Before Adonis, it would take us longer to identify not only what the issue was, but how impactful it would be on our entire book of business. With Adonis, if we have an issue, it will immediately identify it for us, and it will bubble up all of the impacted inventory associated to that particular denial or hold that weʼre seeing.ˮ - EVP of Revenue Cycle Operations

The Impact

The clientʼs billing managers log into Adonis Intelligence daily to check for any new Alerts, and use the Daily Dashboard to spot overarching issues across their revenue cycle. Adonis intelligence empowers the client to be proactive rather than reactive when it comes to addressing RCM issues.

In the scenario to the left, a payer saw a 119% increase in denial rate due to PR16 (a lack of information or billing errors). Adonis identified the issue as soon as it
started happening and triggered an alert to the client so that they could address it in a timely manner.

In another scenario, Adonis identified a rule change with Clover Health that impacted another Adonis customer, promptly surfacing an Alert that helped mitigate a potential $1.5M denial for this customer.

The ROI

• +10% Net Collections: When the client takes action on an Adonis alert, payer NCR performance improved by 10%
• +22% AR Collection Velocity: When the client takes action on an Adonis alert, the client recieved payment 14 days sooner