How blueBriX RCM Transformed Revenue Cycle Management for Ohio Valley Asthma & Allergy Institute
Allergist-Immunologist, Ohio Valley Asthma & Allergy Institute
Ohio Valley Asthma & Allergy Institute (OVAAI), led by Dr Krishna R Urval, is a healthcare provider specializing in allergy and immunology. OVAAI faced significant challenges in its revenue cycle management, particularly with the “buy-and-bill” process, where physicians buy medications upfront and seek reimbursements later from third-party payers. They chanced upon blueBriX particularly for pre-authorization of insurance and over time, blueBriX has become OVAAI’s go-to partner for everything related to billing. This journey has been a continuous learning and scaling process for both OVAAI and blueBriX. The challenges and solutions were non-linear, but within a short period of time, we adapted our RCM solutions to address the specific business and real-time issues of OVAAI. If your healthcare organization is facing any challenge with billing or reimbursement, our story below could be food for thought.
Quickly summarizing, to resolve the challenges OVAAI faced, blueBriX:
blueBriX implemented a robust prior verification and authorization process, ensuring all insurance requirements were met before initiating treatments. Regular follow-ups for claims with Buy-and-Bill Injection codes and detailed monthly reports on high-dollar claims allowed proactive financial management.
blueBriX implemented prior verification and authorization processes to minimize financial risks for providers.
We conducted regular follow-ups for claims with Buy-and-Bill Injection codes and followed up on high-value claims within seven business days to avoid cash flow disruptions.
Our systems provided monthly reports on high dollar claims for better financial transparency and management.
blueBriX introduced real-time checks to identify whether patients’ payers were participating or non-participating. Monitoring protocols were established to promptly flag and report cases where patients switched to non-participating providers, reducing denial rates.
A real-time check on patients helped identify whether they were participating or not. Implemented a front-end process using tailored technology to verify patient coverage before visits, significantly reducing denials due to inactive coverage.
We promptly established monitoring protocols to promptly report cases where patients changed their managed care payer to a non-participating provider, reducing denial rates and preventing future issues.
blueBriX leveraged advanced analytics to identify and address submission pattern discrepancies for insurers like Anthem and Highmark. By aligning claims with the specific criteria of these insurers or the patient’s home plan, blueBriX minimized confusion, reduced delays, and ensured accurate claim submissions for faster reimbursement.
We used high-end technology to analyze claim submission patterns, identifying discrepancies and inefficiencies.
blueBriX aligned submissions with the specific criteria of Highmark, Anthem, or the patient’s home plan, resolving confusion and delays to ensure timely reimbursements.
The Change Healthcare cyberattack created significant operational disruptions for OVAAI, including delays in patient care, cash flow issues, and an increase in AR days due to delayed claims submissions. blueBriX assigned a dedicated team to bring down the AR days strategically and sustainably.
We developed alternative claim submission methods during Change Healthcare outages to mitigate delays caused by system disruptions.
We devised a strategy to clear the claim backlog while implementing processes to maintain AR days at acceptable levels. With blueBriX streamlining operations and addressing backlogs efficiently, OVAAI managed to reduce AR days from 120+ to 35 within three weeks.
We formed a dedicated team to follow up on claims and cross-check EOBs with bank deposits, ensuring accurate payment postings.
Within three weeks, blueBriX successfully resolved the outstanding claims, reducing the AR days to below 35 days in the following month. We also helped OVAAI build a stronger back-office support system, allowing the institute to focus more on patient care.
The back office set up by blueBriX for OVAAI now functions as the backbone of their revenue cycle operations. This allowed Dr. Urval and his team to focus more on patient care, knowing that their financial management was in capable hands.
OVAAI continues to work closely with blueBriX to optimize operations and achieve lasting financial stability. By leveraging blueBriX’s innovative solutions, OVAAI is not only streamlining its operational efficiency but also ensuring it remains focused on its mission: providing high-quality care to improve the lives of patients across the community. Together, OVAAI and blueBriX are setting new standards in healthcare excellence.