Minnesota Eye Consultants Recoups Significant Underpayment Revenue from Its 100,000+ Yearly Visits

Challenge

To accommodate growing patient volume and contract complexities, Minnesota Eye Consultants – an ophthalmology group with 5 clinics and ASCs – needed support for its senior patient contracts manager and transparency into its underpayments and contract compliance. The group’s CFO sought to recoup all revenue earned. 

Solution

The organization turned to MD Clarity’s RevFind to uncover underpayments, evaluate contract performance, and find the data to help them negotiate with payers for more favorable terms and rates of reimbursement. 

Results

• Gained insights on which payers, codes, and combinations of those prompted the most underpayments
• Recovered significant revenue
• Remained current on contract renewals
•  Avoided the need to hire additional FTEs

 “I love using these tools to keep the payers honest!!! We run reports by payers or groups of payers to look for anomalies in reimbursement. The goal is to know where we’re being underpaid.  We know it’s on us to get all our revenue.” 

–Colette Salmanowicz,  Senior Contract Manager 

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A growing organization insists on optimizing revenue

As Minnesota Eye Consultants expanded, growth in patient volume and the complexity of payer contracts outstripped the bandwidth of their revenue cycle team. The then-CFO sought support in the form of a software solution. The ophthalmology group’s senior patient contract manager was handling over a dozen payer contracts for both professional and facility components for more than 100,000 annual patient visits. Further, the front-desk staff and patient accounts team relied on manual eligibility checks and only provided pre-service estimates for high-dollar-value procedures when requested. As Minnesota Eye Consultants grew, the CFO wanted more support for staff as well as better transparency into contracts and improvements in upfront collections and patient satisfaction. 

This Twin Cities-area group specializes in treating issues involving the anterior eye segment, including the cornea, iris, ciliary body, and lens. It provides cataract surgery, laser surgery, cornea surgery, glaucoma surgery, oculoplastics, primary eye care, and more. Each location has an ambulatory surgery center (ASC). The group also heads up research initiatives and is the preferred ophthalmology provider of the Minnesota Vikings.    

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The group had been trying to get insights into underpayments and denials using both the eligibility and the contract management model of its patient management system, but that platform lacked critical features. Without a comprehensive contract management system, no one knew how much revenue they were losing due to payer underpayments.

They also had no way of measuring the performance of their contracts against each other and benchmarks like Medicare. 

With increasing patient volumes and variances in how claims are paid, the group realized they would be limited in the number of payers that they could manually audit.    

Unlike physician groups in specialties with few, simple services, this ophthalmology group had very complex codes and modifiers. They were capturing charges via both professional services and their surgery center. Also, their treatments could involve four or five different procedure codes and multiple modifiers. 

The senior patient contracts manager would review payments from insurers manually one by one. If she found payers had underpaid on a certain code, she would go back and manually check all patients undergoing this treatment covered by the same payer. She could also run a report by payer from the patient management system, but this approach involved manually adding the contract amounts. She’d also have to apply multiple procedure discounts, modifiers, and other payer-specific algorithms. This tedious process dominated her time. 

One underpayment that arose regularly was when the payer would reimburse for only a unilateral treatment when physicians had treated both eyes. In bilateral treatments, payers owe the group 150% of the allowed amount for a unilateral procedure. Also, sometimes a glitch in the payer’s algorithm would throw off reimbursements for a certain code or groups of codes. Further, sometimes payers paid using the wrong fee schedule.    

Minnesota Eye Consultants evaluated several vendors, careful to examine which had the most comprehensive and accurate system for both front-end eligibility verification and pre-service estimates as well as back-end payer reimbursement auditing and contract analysis. MD Clarity demonstrated its Clarity Flow and RevFind solutions to showcase their intuitive and thorough interfaces.

Further, two other large surgical specialty groups provided Minnesota Eye Consultants with product demonstrations and positive reviews. The group selected MD Clarity’s Clarity Flow and RevFind to satisfy their needs on both the front-end and back-end of the revenue cycle.

MD Clarity’s team worked with Minnesota Eye Consultants’ senior patient contracts manager, CFO, and revenue cycle management team to implement RevFind and integrate it with the patient management system. The MD Clarity team uploaded all contracts to the platform. 

In short order, the team was able to find payment discrepancies.

The group’s team knows that it's their responsibility to collect all revenue their physicians, surgeons, and other clinicians have earned. The senior patient contract manager works in combination with the revenue cycle team to contact the payer via their portal, email, or direct outreach to the payer. The team delivers a list of the charges that have been underpaid in the format that the payer requests.  

The senior patient contracts manager also runs audits during contract renewal periods and as needed throughout the year. She benchmarks payers against each other and Medicare rates. Reflecting on each contract’s performance helps her renegotiate terms so they are more favorable to the group. The data unearthed via MD Clarity’s reporting platform provides the rationale for her requests to payers. 

“I appreciate how easy it is to review payments from our contracted payers to make sure claims are paid based on our contract rates."  

– Colette Salmanowicz,  Senior Contract Manager 

The team also uses RevFind to examine denials. When those come through, she provides the information to the accounts receivable team so they can see if something needs to be appealed or has been adjusted incorrectly. 

During regular monthly meetings, Minnesota Eye Consultants share the challenges they are experiencing with payers and their own workflows. They confer on payer trends each side is seeing as well as upcoming product developments. MD Clarity’s customer success team recommends solutions and explains how other clients have solved similar challenges.

During quarterly business reviews, MD Clarity shares performance-boosting opportunities and aggregate underpayments results. 

“MDC has always been responsive to our requests and needs. We have brought forth lots of ideas they’ve incorporated. They are open and listen to our challenges.”

– Sara Julson, Patient Financial Services Manager

Minnesota Eye Consultants is confident that, using RevFind, they are addressing all underpayments and even overpayments that occur in their revenue cycle.

They are pleased that they haven’t had to hire more staff to accommodate their growing patient roster. Indeed, in addition to handling all underpayments and contract negotiations, the senior patient contract manager now has the freedom to handle other group responsibilities. 

Minnesota Eye Consultants is looking forward to deepening their use of RevFind as new features roll out in the months ahead.  

If you would like to uncover your underpayments and recoup your earned net revenue, schedule a demo. We’ll walk you through RevFind’s powerful features and share the successes we've helped provider groups like yours achieve.