Nothing hurts a practice more than a provider completing work and not receiving compensation due to a denial from an insurance company. While serving this patient, you wasted the patient’s time, the provider’s time, materials, documentation time, and finally, the time your front office used to submit the claim. When you add it all up, getting a claim denied is the equivalent of a death sentence for a provider.
Are you ready to optimize your insurance claims and receive more insurance reimbursement? Let’s examine Cool Blue Virtual Assistant’s (CBVA) Insurance Claim Case Study.
We were approached by BAMC, a clinic experiencing a major crisis with just under $4 million in unpaid claims. The clinic was surviving, but cash flow was a serious issue. While BAMC’s front office processed insurance claims, many were being denied. The denials were due to various reasons, from untimely filing to missing medical records and many other issues. As the number of denied claims continued to grow, BAMC decided to seek alternative solutions.
BAMC entrusted CBVA to attack the issue of denied insurance claims due to CBVA’s expertise in insurance recovery and cost-effectiveness. CBVA recommended the installation of four insurance specialist VAs and began insurance claim recovery efforts for four months.
The process involved countless hours navigating insurance portals, providing pertinent information through correspondence, and staying on hold for an average of 35 minutes for each claim. It became apparent why so many of the clinic’s claims were denied. The front office simply did not have enough time to chase all of these unpaid claims, and new claims needed to be filed in addition to other front office responsibilities.
This arduous process continued for four months, but progress was made with each successful reprocessed claim. Due to diligence, persistence, and navigation of the proper channels, BAMC recovered and generated $112,000 in unpaid claims. This alone represented $28,000 more in cash flow each month and allowed BAMC to allocate resources to more insurance claim recovery and operational efficiency.
In our case study, if an insurance recovery strategy had been conducted in-house, the cost would have amounted to $84,480 using the average wage of $33/hr for a US-based insurance specialist. Based on $112,000 generated from reprocessed claims, this represents a net profit of $27,520. However, by utilizing the cost-effectiveness and expertise of Cool Blue VAs, BAMC realized a net profit of $86,528, which is three times as much! This solidifies the efficacy and need for Cool Blue Virtual Assistants.
When you factor in the time needed for interviewing, training, and onboarding you understand why most clinics do not pursue an in-house insurance recovery strategy due to it being labor-intensive, costly, and underwhelming financially.
When evaluating the best use of a clinic’s finances, it is prudent to evaluate the return on investment (ROI) before implementing changes.
Regarding finances, most consider investing in the S&P, which historically averages 8-10% returns, a smart bet. If you analyze deploying an in-house insurance strategy, you would net a 33% ROI. However, because BAMC utilized Cool Blue VA insurance specialists, it realized a staggering 340% ROI! This means that for every dollar the clinic spent, it returned $3.40, making this the investment of a lifetime.
The great news is that a Cool Blue VA insurance specialist costs $9.95/hr, which is less than a third of a locally sourced specialist. Most importantly, we get the job done. We mean it when we say, “Maximize performance at a fraction of the cost.”
If you want to experience more processed insurance claims, generate more revenue, and grow your practice, please schedule a practice analysis.
