Revenue Cycle Management Transaction Data Analysis
Company History
Project Background
Superlative Dermatology is a leading skincare company known for its innovative solutions and exceptional results. With a team of experts, they offer advanced treatments and products to address diverse skin concerns, setting new standards in the field. Established in 2005, Superlative Dermatology is a trusted name in the industry, dedicated to revolutionizing skincare practices.
Analyze the transaction data to help Superlative Dermatology to improve their process to optimize their financial health.
Transaction Summary
I created a transaction summary to review the total charges, total adjustments, and total payments that occurred in 2021 and 2022.
Payer Type Summary
The following shows the summary of payer transaction dollars. 44% of the payer type come from a government agency (Managed M/M, Medicare, Other Governmental)
CPT Product Summary
The following shows the top 10 CPT codes used in 2021 and 2022. The top 10 represents 73.5% of total charges for this clinic.
Recommendation
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To reduce number of denials. The top 4 reasons for denials were due to non-authorization, non-covered, timely filing, coding issue, and information request. These denials make up 84% of denial cases.
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Suggestion to create an incentive plan to motivate the staff to reduce number of coding issue, information request & timely filing. Also, part of the incentive plan is to reduce number of non-authorization and non-covered by verifying the patient information with the insurance company.