Infusion Services Case Study

Digital revitalization of RCM for the largest ambulatory infusion provider delivers a $28 Million revenue surge

About

In the dynamic landscape of healthcare, a leading southwestern private equity-funded organization dedicated to outpatient infusion management services faced challenges in sustaining financial health amid rising labor costs and operational complexities within the revenue cycle process. With a commitment to delivering unparalleled patient care, comfort, and clinical outcomes, the organization operates over 300 infusion clinics across the nation, specializing in infectious disease, gastroenterology, neurology, rheumatology, allergy, immunology, and pulmonology.

Challenges

The organization encountered escalating labor costs and operational hurdles within the revenue cycle, resulting in increased denials for prior authorizations, delayed follow-ups on denied claims, manual payment posting, and claims status updates. These challenges not only affected same-day patient authorizations but also led to delayed cash flow for partner medical groups.

Solution

Harnessing the Power of Digital Innovation

In the journey to overcome challenges, Ascent deployed an ambitious digital strategy through its pioneering ARMS Ai service platform. The strategy was multifaceted, focusing on digitizing the revenue cycle services to usher in a new era of financial health and operational efficiency.

Digital Transformation with ARMS Ai

At the core of the transformation was the integration of a robust digital infrastructure, characterized by:

Strategic Automation

With over 1,600 processes across the top 10 players in 32 states automated, Ascent Health significantly reduced the necessity for manual interventions, thereby substantially enhancing efficiency and minimizing the likelihood of errors.

Advanced Ai Algorithms

Ascent Health implemented sophisticated rules-based Ai algorithms designed to navigate the complexities of the revenue cycle with precision with minimal human intervention.

Ai and Machine Learning Innovation

The platform harnessed the predictive power of machine learning, analyzing vast datasets to anticipate and adapt to the nuances of payer behaviors across different states and providers.

Industry-Leading Protocols

By adopting best practices and protocols, we ensured that every digital action was in line with the highest standards of the healthcare industry.

Transformative Outcomes

The healthcare organization experienced a remarkable $28 million increase in cash flow, coupled with an impressive 25% reduction in operating costs. Ascent successfully authorized over 210,000 procedures annually, encompassing critical treatments such as J1823, J3241, J1303, J1554, and J2350. Remarkably, more than 50% of these procedures were scheduled on the same day, with a rescheduling rate consistently below 10%. Ascent’s implementation of automated payment posting, streamlined claims status updates, and standardized appeals processes.

Enhanced Process Accuracy

The accuracy of operational processes soared above 95%, a testament to the efficacy of the automation and AI-driven systems in place.

Open Loop Modeling

By employing Open Loop modeling techniques, Ascent Health could dynamically evaluate over 1,000 machine learning models, ensuring that the resolution of open inventory was handled with unparalleled proficiency.

Best-in-Class Performance

The ARMS Ai platform’s ability to tailor its approach at the payer, state, and individual provider levels resulted in performance metrics that set new industry benchmarks.

95%

Improvement
in process accuracy

28%

Increase
in cash flow

50%

Procedures
scheduled on same day

25%

Reduction
in cost-to-collect

210,000

Procedures
authorized annually

The digital strategy’s implementation not only addressed the immediate operational challenges but also laid a foundation for sustained excellence and innovation. As a result, Ascent Health Solutions not only transformed its operational landscape but also positioned itself as a leader in the digital transformation of healthcare revenue cycle management.

“They have the people, they have understanding, and they have outcomes.”

Senior VP of Revenue Cycle Management

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