RCM Consulting – Primary Care

Case Studies

Client Profile

RCM Consulting – Primary Care

SCALE was engaged by a client in the primary care specialty to improve their Revenue Cycle Management (RCM) performance. Through collaboration and data-driven changes, SCALE assessed and made recommendations for policy updates, procedure enhancements, workflow implementation, and the development of industry-standard KPIs. The results included increased accuracy in coding, reduced claim lag time, improved denials management, and decreased outstanding debt.

Client Profile

MSO Integration – IT Systems / Revenue Cycle Management

Our Client wanted to integrate three separate practices into one single practice and sought SCALE’s multi-disciplinary expertise to achieve this goal.

Platform Strategy, Operations and Development

SCALE was tasked with a ‘blank slate’ mandate for one of its clients. The Company was stable, had no debt and a positive cash balance, was cash flow positive and growing, but was looking for outside guidance on how to further improve its business and operations.

RCM for a Multi-Specialty Practice

SCALE began working with a multi-specialty practice with approximately forty providers on a host of performance improvement initiatives. The practice decided that it had insufficient leadership and expertise to improve and turn around its billing operation and so it engaged SCALE to provide all RCM services. In a matter of weeks, SCALE took over the billing function and began improving performance.

Client Profile

Coding Performance Oversight – Primary Care

Our Client consists of one high volume practice with four specialties. The Client is an active participant in government/commercial payer initiatives to deliver value-based care. They had not implemented a robust coding and clinical documentation program and recognized this as a key strategic area for performance improvement..

Client Profile

Post-Close Integration

Our Client completed a sizable acquisition expanding their footprint in additional states. The Company had not completed a transaction of this size previously and was seeking support to develop a holistic integration strategy across core functional areas. Further, the Company was experiencing specific pain points in its current IT and RCM departments and was seeking guidance on how to address these pain points and how to develop the right integration strategy in the context of these pain points.

Client Profile

Fully Managed Diligence

Our Client is a highly acquisitive MSO with operations across seven states and seeking to continue its rapid add-on M&A activity across transactions of varying sizes from small solo practice tuck-ins to larger multi-site add-on acquisitions.

Performance Improvement Case Study #1

BACKGROUND & CURRENT STATE – A DSO based in Tennessee with just under 100 clinics in five states approached SCALE Healthcare with cash flow & liquidity issues. The client was growing at a rapid pace and had experienced issues integrating new practices into its existing RCM program. In the past year, RCM deficiencies resulted in lower accrual forecasts and there was a lack of central oversight of their RCM structure.

Client Profile

Revenue Cycle Management – Dermatology

  • Our Client wanted to urgently remove their RCM leader and redeploy associated RCM resources as their internal RCM department was underperforming
  • Our Client’s lack of denial and AR management was resulting in high Days in AR and %AR > 90 days.
  • Remittances were not entered in their system, including expired checks and credit cards never credited, and they had multiple unposted Electronic Remittances with little reconciliation to their bank account.
  • The Client also had a lack of follow up on credentialing causing denials and appointment woes.

RCM Diligence – Fertility

Our fertility platform Client was acquiring multiple regional practices simultaneously and their prior RCM vendor was not providing specific knowledge and insight required to accelerate post close activity.

Our Client needed a diligence assessment of their target RCM team and processes, which included the need to …..