CAH (Cardiology)

Fedora began by analyzing existing workflows and implementing a suite of custom reports using the practice’s EMR. This provided clear insights into charges, collections, collection ratios, and key AR issues. Fedora not only optimized billing rules but also enhanced the EMR’s functionality, streamlining communication and ensuring better protection of patient health information (PHI).

Inconsistent workflows for capturing authorizations led to high denial rates and unexpected patient balances. Fedora’s proprietary technology streamlined the process, reducing missed authorizations and denial rates. With a turnaround time of 1.32 days on 99.3% of the 1,844 monthly authorization requests, the practice significantly decreased patient wait times for procedures.

One of the practice’s main challenges was the timely and accurate submission of claims. Many claims were still being submitted on paper, causing delays and lost claims. Fedora ensured that 90% of claims were submitted electronically, speeding up the processing time and enabling faster payments. Additionally, the team automated submissions for complex claims, such as transplant department claims, which were previously delayed due to paper-based processes. Fedora also enrolled the practice in electronic remittance and payment programs with all major insurers, which improved cash flow and shortened the aging cycle.

At the start of the engagement, there was a significant opportunity to streamline AR follow-up processes. Fedora quickly addressed this, collecting on aged AR, correcting posting errors, and implementing routine follow-ups. The practice saw a 50% reduction in AR over 120 days, from 19% to 9%, and the days in AR were cut from 52 days to 29 days, with a clear path to reduce both metrics even further through collaborative workflow improvements with the practice.

Cardiology Associates experienced above-average denial rates due to gaps in front-end workflows and charge posting. Fedora identified the root causes of these denials and collaborated with the practice to implement improvements. As a result, the denial rate was reduced to 4%, half the industry standard of 8%.

“Working with Fedora has helped our practice transform our authorization and billing processes. They know the Hawaii payer market well, and they understand the particulars of our specialty. Fedora is very proactive and collaborative with our team. We’re happy to endorse Fedora for any practice looking to improve their revenue cycle processes.”

– William M. Dang Jr., MD