Retinal Vitreal Consultants: A Case Study

Retinal Vitreal Consultants, specializes in Ophthamology in Northeast Chicago, serving their community since 1981. The practice encountered various challenges, including inconsistent benefit verification & timely prior authorization capture, staff training and turnover concerns, and a lack of visibility into the revenue cycle. After implementing RCM with Fedora, the practice experienced remarkable improvements in their operations. The streamlined processes and automated workflows resulted in a significant reduction in AR aging and improved cash flow. With a clear overview of their AR aging and a workflow designed for timely prior authorization, the client can now focus on delivering exceptional care to their patients.

Practice Anaylsis and Reporting Suite

Fedora immediately reviewed current workflows and reporting capabilities. Our Analytics team plugged in and developed a suite of customer reporting, using the practice’s own EMR, to give insights into charges, collections, collection ration, problematic AR issues, and quick wins to stop revenue leakage.

Authorization Process Optimization

The practice had inconsistent workflows for capturing Authorizations, with high numbers of denials and unexpected balances for patients due to the missed Authorizations. Fedora deployed our proprietary processes and technology, effectively eliminating missed Authorizations and Authorization denials.

Outstanding AR Cleanup

A sizeable opportunity to systematize and standardize AR follow-up processes existed at the start of the engagement. Fedora stepped in rapidly, collecting on aged AR, corrected posting errors, and implementing routine follow-ups on all claims.

Denial Management and Process Improvement

The practice had an above-average denial rate due to gaps in the front end and charge posting workflows. Fedora organized the denials, identified drivers, and collaborated with the practice to make changes that dramatically reduced the denial rate.

  • Aging >120 days: reduced by more than 50%
  • Days in AR: from over 35 to less than 27 days
  • Denial %: reduced and maintained at less than 4%

“The team at Fedora have become a valuable partner to our practice to facilitate the complex medical billing process. We were impressed by the amount of time they spent to learn our workflows and how quickly they could adapt to any necessary changes. Their KPI reports were customizable and instrumental in helping us to understand and follow the health of our practice. Furthermore, the service was reliable and easily scalable as our practice grew larger. We look forward to continuing a successful relationship with Fedora.”

– Dr. Shaun Ittiara, MD, FACS, FASRS