Our Client Results / Billing & RCM 

Medical Advantage Solves Multi-State Pediatric Therapy Group Accounts Receivable Issues 

Results

Optimized

70+

payers’ fee schedules in the practice management system 

Enrolled

100

payers with the clearinghouse with electronic claims submission enabled and ERAs and EFTs set up 

Over

1,000,000

In AR rebilled and collected over two years

Overview  

A multi-location pediatric therapy group specializes in special education, homebased, and early intervention services. Their comprehensive and collaborative approach to therapeutic care for children has resulted in high retention rates as patients thrive in home, school, and community environments. 

Challenges

The pediatric group approached Medical Advantage for front EHR optimization with the goal of maximizing reimbursement. An EHR that runs smoothly, converts providers correctly, and ensures authorizations was the top priority. During the optimization process, the following issues were revealed. 

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Inflated fee schedule

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Unclean claims being billed out incorrectly

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Untapped reimbursement opportunity

Our Solutions

Our consultants applied their rich healthcare background, including experience in typical operations such as billing, to develop a more stable RCM structure for the client. 

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Refiled claims

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Improved authorization process

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Corrected fee schedule

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Improved AR projection accuracy

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Discovered and activated denial management tool available to client but being unused

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Set up ERAs/EFTs with insurance payer

Medical Advantage Can Help

Medical Advantage is an innovator in healthcare. Our years of experience, data driven strategies and in person approach drive change, improve outcomes, and maximize ROI. Our team has the expertise to provide customized, actionable solutions to decrease the cost of care and improve quality for your practice.

Medical Advantage - TDC Group