Case Studies
Case Study 1: Recovery of $1.1M+ in Missing Payments for a Dermatology Practice
The Problem
A specialized Dermatology and Mohs surgery practice in New Jersey faced an enormous oversight:
- $1,148,591.74 in unclaimed Virtual Credit Card (VCC) payments from Horizon BCBS over three years.
- 1,519 payments were marked as 'paid' within the Practice Management System (PMS) but never deposited into the practice's accounts.
Our Approach
PACT RCM discovered this discrepancy within the first week of collaboration and acted swiftly:
- Conducted a meticulous comparison of records against bank deposits to uncover missing funds.
- Advocated for the client by contacting BCBS to reissue past VCC payments and enrolling the client in Electronic Funds Transfer (EFT) to prevent future issues.
The Result
Successfully recovered $1.1M in reissued payments within a month.
Transitioned the client to EFT, saving them from VCC transaction fees and ensuring a streamlined payment process.
Impact
This recovery not only stabilized the practice's finances but also enabled better resource allocation, enhancing patient care delivery.
Case Study 2: Preventing a $100K Oversight During a Medicare Audit
The Challenge
A healthcare provider undergoing a Medicare audit faced a critical oversight:
- Supplemental Medical Review Contractor (SMRC) requests for medical records were missed due to incomplete information submitted by a third-party vendor.
- Medicare dismissed the documentation, leading to potential revenue loss of approximately $100,000.
Our Solution
The Challenge A healthcare provider undergoing a Medicare audit faced a critical oversight:
- Reviewed all pending claims and provided guidance on accurate submission of medical records.
- Established a proactive process for SMRC requests to ensure no details were overlooked in the future.
- Implemented a robust audit response strategy to recover lost claims and protect the provider from further scrutiny.
The Outcome
- Secured recovery for a significant portion of the affected claims.
- Implemented safeguards to ensure compliance and avoid future administrative oversights.
Impact
The provider regained financial stability and confidence in their revenue processes while maintaining compliance with Medicare regulations.
