The Story of Community Wellness Center
In 2013, a mental health group practice and the freestanding general clinic were formed to service persons housed in affiliate assisted living facilities. Three years later, the practice developed into an outpatient mental health clinic and psychiatric rehabilitation program. It relocated to Highlandtown at that time. The medical primary care services recently moved to a larger more suitable facility in Downtown Baltimore. The mental health programs were awarded accreditation by the Joint Commission in 2017 and CARF in 2018. Later that year, the psychiatric rehabilitation program received approval to provide health home services, and a community outreach office was opened to make services accessible to residents of Anne Arundel County.
Specialty: Mental & Behavioral Health
• Outpatient Mental Health
• Health Home
• Psychiatric Rehabilitation
• Housing Referrals
• Referrals to additions Treatments
• Primary Care and Family Medicine
Location: Baltimore, MD
No. of Providers: 35
Why CWC made a deal with Aegis
Service can’t be seen until you experience it, so we have designed a contract for 3 months to prove it.
We decided to charge only 50% of the agreed fee if the claim gets paid after 45 days if we are responsible for the delay.
The challenges of CWC and how Aegis encountered
1. Unbilled Charges
Problem: When Aegis took over, there were a lot of unbilled claims from October 2019 till October 2021. Aegis has billed all the claims within 2 months and received the payments.
How Aegis encountered: Aegis’s used its Certified dedicated professional and identified unbilled claims and transferred all the claims within 30 days upon 100% Coding Audit.
2. Patient Statements have never been sent in the last year
Problem: Patient statements were never sent, aegis explained the importance of the patient
collection, and created an advanced easy tool to speed up patient revenue.
How Aegis encountered: Aegis’s team of Patient Billing Support experts carefully reviewed every patient who has co-insurance and deductible outstanding and,
• Mailed Statements
• Sent gentle text reminders
• Setup a dedicated Toll-free number to assist patients over the phone with
their statement related questions.
3. Unsigned Charts:
Problem: Aegis found a lot of unsigned charts and created a spreadsheet with unique sheets
for all different types of programs and sent the list clinical team to sign the charts and billed
the claims to insurance.
How Aegis encountered: Charts were incomplete with certified coders Aegis has coded all the
claims and billed the claims for payments. Aegis’s Certified Specialty-specific Coders found a lot
of unsigned charts and created a secure HIPAA compliant spreadsheet and separated the charts
by program and requested the providers of CWC to sign off the charts.
4. Under Payments:
Problem: Fees schedule was not updated by the old billers; Aegis corrected all the claims which
were underpaid and received full payments and updated the correct fees schedule for the
current billing cycle.
How Aegis encountered: One of the first things that Aegis did was Fee Schedule Analysis and
found that CWC was underpaid because of underbilling. Aegis’s Certified Professionals have set
the fee schedule to 150% of the Medicare Fee and rebilled all the underpaid claims and collected
5. Unaddressed Denials:
Problem: Denials percentage was around 35% for the current billing, Aegis identified the
solution to the denials like (Inclusive, LCD, noncovered, covered by another provider,
Authorization, TFL, payer guidelines, COB denials, Eligibility, and all coding related denials
were addressed and billing SOP was created to overcome the denials and Aegis was able to
bring the denials to 6%.
How Aegis encountered: One of the first things that Aegis did was Fee Schedule Analysis and found that CWC was underpaid because of underbilling. Aegis’s Certified Professionals have set the fee schedule to 150% of the Medicare Fee and rebilled all the underpaid claims and collected the differences.
Aegis’s Certified Professionals unearthed the claims those got denied because of the following
reasons and addressed them,
• Invalid code
• Rendering provider missing
• Inclusive denials
• Non covered
• Covered by another provider
• Authorization not found
• Payer guidelines not met
6. Less Collection & Huge AR Outstanding:
Problem: Payment posting and billing logs were not maintained, Aegis created a billing log for posting and current billing to track the billing logs, started sending Daily reports and weekly progress reports about the project highlights and tasks Aegis completed.
How Aegis encountered: Not just the low-hanging fruits, Aegis’s Certified Professionals got the high-hanging fruits down too. The team went after every outstanding claim and resolved each and every claim to increase the collection significantly.
Security measures – Out of the Box Solution by a Billing Company
- Aegis CWC’s Management to co-ordinate with their billing team to address their email in order to provide the data, medical records, per-auth cases, details of their Contracts with insurance companies, and immediate responses on some issues that they address.
- Aegis and CWC started meeting every Wednesday to go over the progress, pending items, and next priority. This communication made the process smoother and CWC started seeing the Progress on the board.
- The audit wasn’t regular with previous billers. Aegis implemented an Auditing team for current billing and AR audits and posting audits to bring the best quality and increase the ratio of the payment.
- Aegis team underwent a proper training session for a few weeks in all mental health programs and the team was fully trained on the guidelines to be followed for each program and completed the action as per the payer guidelines.
- Aegis identified lot procedure codes that were not billed, old billers missed to bill the CPT codes, Aegis worked on a special project named – Project HH, PRP, SUB spreadsheet the team audited and billed the missed claims and recovered payments.
- Aegis helped the billing group to clean up the Account receivables and the huge debt amount was offset with help of the Aegis team
- The topmost priority was given to the aged account receivables. Aegis pulled the entire pending claims and divided them to assign the priority. More valued claims and the claims were nearing the timely filing.
- A huge number of paid claims were not posted in the years 2019, and 2020 Aegis team worked with the EHR development team to create a feature that will automate the posting and reduce the Manpower to maintain the billing reports.
- Aegis identified denial reports which can be retrieved from the payer portal and cleared the workable denials with high priority.
- To collect Patient responsibility on time to avoid surprise bills, Aegis set a rule to send the Patient statements.
- Documentation task in Medicaid portal was not completed, Aegis team helped the billing company to complete the tasks.
- Aegis team supported the clients whatever the tasks assigned to them and completed within time and helped the billing process.
“I see less rejections and denials are going down.
our revenue is going up and its pretty steady.
I am happy to see this. it seems like you all have a good work flow, and thank you. I do appreciate your hard work”
Vernon Holmes, Jr., MBA
Chief Executive Office
Collections increased to 3X and Expenses reduced to 50%
The average collection was around $250,000 before aegis took over the billing process and within two months the average collection was made up to $974,000 (as of Feb 2022) per month on an average of five months.
The percentage model fee was around $20,000 per month and then when they decided to switch, their expenses raised to $34,000 to $36000 per month. Once Aegis made a deal with them, their expenses has been reduced to $20,000 to $24,000 because of the increased collections. Aegis, proactively stepped in with a Full Time Employee Model so that, CWC can save lot more money and now the actual expense for the billing is $16,000.00 per month.
Many medical groups or practices feel they are experiencing good cash flow. Because the top management may not be exposed to the hidden areas or loopholes of revenue cycle management. Especially when they making big money, they see some healthy numbers but there are many chances where there is a revenue leakage starting from $5000 to $25000 a minimum per month.
Auditing once in three months is always a good practice to avoid such mistakes. Aegis healthcare solution can do this by going over the last One-year billing and can fix it.
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