Case Study: Insurance Verifications and Authorizations for a Podiatry Specialty in Raleigh, NC

Case Study: Insurance Verifications and Authorizations for a Podiatry Specialty in Raleigh, NC

Insurance Verifications and Authorizations for a Podiatry Specialty in Raleigh, NC

Overview

Outsource Strategies International (OSI) has more than 17 years of experience in providing customized patient eligibility verification services for various medical specialties. Our client is a podiatrist from North Carolina who contacted us to verify their patients’ insurance benefits before services are provided.

The Challenge

In this podiatry practice, the insurance verification & authorization process was very time-consuming for the in-house staff, making it difficult to keep up with the work. They couldn’t find enough time to do the work.

To get the process done, phone calls need to be made to the insurance companies, and that requires a long time between long hold times and gathering the information the practice needs. They wanted experts in the field, who could really concentrate on getting this very important information in a timely manner.

To assist them and to effectively do the job, we needed to know the ins and outs of insurances really well.

The Solution

We took over their verification and authorization process and freed up their staff so that they could concentrate more on their other services, and provided excellent care for their patients.

Result

The client was really happy with the eligibility verification and authorization process our team provided.

Reason being, we were experienced in working with government payers as well as commercial insurance companies such as Blue Cross Blue Shield, United Healthcare, AETNA, and GHI. When we take this back-office work off our clients’ plates, it gives them time to focus on patient satisfaction, and grow their practice.

Case Study: Comprehensive Insurance Verifications for Two Busy Dental Offices in Westchester and Manhattan

Case Study: Comprehensive Insurance Verifications for Two Busy Dental Offices in Westchester and Manhattan

Insurance Verifications for Dental Offices

Overview

An experienced hand in providing dental insurance verification services, Outsource Strategies International (OSI) provides reliable services for diverse busy dental clinics, practices and offices. Our client who manages two busy dental offices in Westchester and Manhattan has been providing advanced dentistry procedures and comprehensive dental procedures for years to help improve patients’ oral health.

The Challenge

The client has 2 very busy practices and they are very particular about how they want things done. These offices have to spend an enormous amount of time to speak to insurance companies, which delayed their other office duties and patient care.

The Solution

Our team worked directly on their practice management software and checked the patient’s active primary and secondary insurance benefits. Our verification team obtained all details such as co-payments, deductibles, co-insurance, patient policy status, effective date, type of plan, coverage for different procedures, prior authorization requirements, claims mailing address, and more. We utilized 2 FTEs to work on their process daily. We worked directly from their schedule and maintained a 5-day-lead on their appointment schedule.

The client’s office is then able to explain the patients’ out-of-pocket costs before the point of service and coverage available under their insurance plans so there are no surprise dental bills.

Results

The client has been very happy with the quality of the verifications and the process performed.

The verification form that we followed for this is very extensive, making the verification process for each one timely. Our team is currently implementing the Piece Rate model and handling the volume with a 24-48 TAT.

Need customized dental insurance verification support? Call us at 1-800-670-2809!

Case Study: Dental Insurance Verifications Done Successfully for U.S. Based Dental Practice

Case Study: Dental Insurance Verifications Done Successfully for U.S. Based Dental Practice

Dental Insurance Verifications Provided for Dental Practice

Overview

Outsource Strategies International (OSI) has been providing dental insurance verification and prior authorization services to dental offices in all 50 States, for many years. This client is a U.S. based dental practitioner, a one-physician practice located in Washington DC, who needed our support in verifying patients’ coverage, to streamline their front office operations and improve the quality of patient care.

The Challenge

The entire staff here was busy dealing with patients and providing quality care. The client contacted us for accurate dental insurance verification services. They needed 10-20 verifications to be completed per month.

The Solution

The verification form that we follow for this client is very extensive, making the verification process for each one time-consuming. “Extensive” in the sense, they had a whole lot of codes to be specifically verified and wanted extra information on them as well such as limitations and frequencies. We implemented the Piece Rate model and handled the volume with a 24-48 TAT. We found that pricing per verification was in the best interest of the client, due to how extensive the form is but also with the low volume due to COVID. We were able to price the piece rate to be cost effective for both the client and us – win-win for sure. To implement this Piece Rate model,

  • We spoke with the team about realistic expectations regarding how long it would take to complete each verification using the client’s form
  • Worked out the price per verification to benefit both parties.

The Result

The client is very happy with the quality of the verifications and the process. Piece Rate model is essentially like paying per piece. No issues have come up so far. The team has handled the verifications really well and the client remains satisfied with our services.

Case Study: American Teledentistry Company Extremely Happy with OSI’s Insurance Verification Services

Case Study: American Teledentistry Company Extremely Happy with OSI’s Insurance Verification Services

Insurance Verification Services

Overview

Outsource Strategies International (OSI) has been providing a Tennessee-based American teledentistry company with insurance verification services since January 31, 2017. This client manufactures clear aligners, which are orthodontic devices that use incremental transparent aligners to adjust teeth as an alternative to wearing dental braces. Their aligners are BPA-free and it does not require any office visits as everything is done remotely.

The Challenge

  • The client was struggling as they were receiving a large interest in their product but were unable to keep up with questions about insurance coverage.
  • They had little knowledge of the insurance verification processes and were desperate for help.
  • They are a remote company and do not have the staff or expertise to complete this task.
  • They wanted a company that could verify whether or not prospective patients had valid insurance and whether their insurance covered the product that they manufactured.
  • They had a lot of trouble locating a company that could work with them to customize a solution that would help them grow.

The Solution

We are currently staffing 7 full time equivalent (FTE) employees who provide insurance verifications for this client. We started off initially with 3 FTEs but increased the manpower as needed in response to the client’s growth. We consistently provide flexibility in our services and delivery providing good quality verification services. The client is extremely happy with the quality and efficiency we provide.

All of the client’s questions and concerns are handled properly. We conduct bi-weekly meetings with the client to address any issues or concerns they may have and provide expert recommendations on process improvements. The client has peace of mind knowing that they only need to concentrate on marketing their business and keeping their patients happy.

Results

The client is very pleased with our services and pricing, and has also appreciated the consistent quality. This is an ongoing project and this company has been with us for over 8 months now. It seems the client would like to continue our business relationship indefinitely.

Case Study: American Teledentistry Company Extremely Happy with OSI’s Insurance Verification Services

Case Study: Insurance Verification Deftly Handled for Healthcare Company Clients

Insurance VerificationOverview

Outsource Strategies International (OSI), a Managed Outsource Solutions company, provides insurance verifications for all medical specialties including urology. Our client, the Minneapolis, MN based Coloplast, provides products and services to help people suffering from various private medical conditions such as those affecting the testicles and penis, erectile dysfunction and Peyronie’s disease.

The Challenge

Coloplast was on the lookout for a cost-effective solution to enable urologists to carry out procedures with their products. They needed a partner to work with the urologist and secure insurance information for each of these procedures for which Coloplast was providing products. This insurance information was a service Coloplast offered since it was committed to extending support to physicians all over the United States to help them serve patients better.

The Solution

OSI devised a scheme by which the urology offices can contact us directly to get themselves set up for our service. Before a urology office schedules a patient procedure, OSI verifies the insurance eligibility and benefits of the patient. We also check the active primary and secondary medical coverage of the patient with the insurance company and confirm details including:

  • Co-payments
  • Deductibles
  • Co-insurance
  • Patient policy status
  • Plan type
  • Effective date
  • Procedure coverage
  • Prior authorization requirements
  • Claims mailing address

This enables the urology offices to schedule procedures confidently and have a clear idea of the available coverage under their respective insurance plans.

Results

Beginning with one urology office in July 2013, OSI now works with 16 offices all over the United States as part of the ongoing project with Coloplast. Coloplast is now able to raise its revenue thanks to this very useful service it provides through OSI. There are no longer any issues in getting the verifications done. Coloplast is now able to fully focus on helping its clients.

The client is very happy with our service. As L. Doran, CPC – the reimbursement specialist of Coloplast says, “I’m very grateful for the work you and your team have put in to make our Benefits Verification Service work so well. Thank you for handling everything quickly, efficiently, and always with grace and humor.

Case Study: Coding Audit for 700 Surgical Charts Handled on Time

Case Study: Coding Audit for 700 Surgical Charts Handled on Time

Overview

RADV Audit ServicesOSI (Outsource Strategies International) offers medical billing, medical coding, insurance verification and other comprehensive medical outsourcing solutions. Our services were required by Omega Medical Solutions of Myrtle Beach, South Carolina. Omega is a comprehensive outsourcing partner offering financial and business technology functions including general accounting, consulting and reporting. The services they offer include:

  • Consulting Services
  • Coding Audits
  • Charge Entry
  • Payment Posting
  • Denial Analysis
  • Insurance Claims and Self-pay Follow-up
  • Collections
  • Refunds
  • Financially allows a practice access to industry-leading technology through ASP with EMR

The Challenge

They needed our assistance in May 2013 since they were unable to keep up with an audit for 700 surgical charts, which had to be completed in two weeks.

The Solution

We were able to put together a certified and experienced surgical coding team. They completed the coding audit for 700 surgical charts in two weeks, as per the client’s requirement.

The Result

The client benefited enormously from our services since they really needed some experienced coders to handle the audit, particularly considering the time constraints they had. But it turned out to be business as usual for us. This was a one-time project that was completed in 2 weeks. The client was extremely pleased with our medical coding audit services since we were able to fulfill their needs. We still keep in touch with client, and they intend to use our services again if a need arises in the future.