Best Revenue Cycle Service Provider

Customer’s Problem:

A large physician group had challenges collecting patient payments at the time of service. They approached Pena4 seeking support to streamline the process and expedite point of service or over the counter collections

Solution:

• Pena4 used the patient scheduler to verify eligibility and benefits 48 hours prior to the visit
• Leveraged ANSI transactions to perform real-time eligibility and benefits
• Accessed payor portals, Interactive Voice Response (IVR) to obtain detailed benefits
• Called insurance representatives as and when required
• Reviewed the coverage and coordination of benefits to bill the appropriate payor
• Calculated out-of-pocket expenses like deductibles, coinsurance and copays for the services covered by the payor prior to the visit
• Identified benefits that aren’t covered by the insurance plan and proactively communicated to the patient during the visit.

Outcome:

• Patient Satisfaction
• Reduction in man hours and cost to generate patient statements
• Improvement in bottom line by 10%
• Reduction in claim rejections by both clearinghouse and payor
• Reduced claim denials pertinent to patient access services by 3%