Client Overview:
Newly launched specialty pharmacy focused on chronic care. Initial operations included manual claims management and limited revenue tracking.
Goal: Achieve operational scalability, improve cash flow, and enhance financial transparency.
Challenges Faced:
- Low claims payout rate (below 60%) impacting cash flow.
- Delays in reimbursement cycles averaging 45–60 days.
- No real-time visibility into revenue or aging receivables.
- Heavy dependence on manual processes, leading to frequent errors and resubmissions.
PhysiAssist’s Plan of Action:
- Implemented automated claims management system to reduce human errors.
- Integrated real-time revenue and claims tracking dashboards for leadership visibility.
- Standardized claims submission and denial management workflows.
- Provided ongoing staff training and support to ensure adoption within 30 days.
- Introduced predictive analytics to proactively flag high-risk claims.
Results(Achieved in 90 Days):
- Payout rate improved to 94%, up from <60%
- Claims cycle reduced to 18 days, accelerating cash flow.
- Real-time revenue tracking enabled, allowing for instant decision-making and forecasting.
- Manual intervention reduced by 70%, freeing staff to focus on patient care.
- Revenue leakage reduced by $250,000 through improved denial management and follow-up.