U.S. Dermatology Partners Overcomes Staffing Challenges to Achieve Better Claim Rates

Like many healthcare organizations, U.S. Dermatology Partners experienced ongoing staffing challenges as a result of the COVID-19 pandemic; in March 2020, their CBO staff was reduced by 60%. Over time, as they began restaffing positions, only 25% of those positions were filled, leaving a significant number of open positions.

Simultaneously, the group was rapidly growing. U.S. Dermatology Partners needed to add new providers and seamlessly expand without adding new billing and coding staff to handle the additional workload.

However, their teams were spending a lot of time and energy combating billing and coding errors. Due to historically manual processes, they were faced with high rates of rejections and denials. Their charges would pass from the EMR to their PM system with numerous errors that needed to be manually corrected and re-entered.

To combat these inefficiencies without hiring, they needed to do more with less.

U.S. Dermatology Partners implemented NextGen® Charge Review Rules Engine (NextGen Rules Engine) to automate the charge import and review process. By eliminating the time-consuming manual entry work, they were able to reallocate employees from several teams despite their initial staffing shortages.

The group was able to reduce two full-time positions and reallocate another two full-time positions on their Charge Entry Team. They reduced manual charge entry time by 11 hours per day and automated charge cloning, missing charge reconciliation, and practice transfer.

On their A/R Team, they were able to reduce four and a half full-time positions and reduce denial tasks by 22%. Similarly, on their Coding Team, they were able to reduce two full-time positions and reduce coding denial tasks by 75%. In all, they were able to reduce or reallocate over ten full-time positions.

In addition to remedying their staffing challenges, these changes positively increased staff morale and allowed for more professional growth among their existing staff. These simplified processes eased staffing turnover and reduced the administrative burden on the IT team.

Finally, these upgraded workflows expedited and increased clean claims. Their date of service to claim submission time was reduced by two days, while their clearinghouse and payer rejections decreased by 3%. Backend rejections went from 40% of total rejections to 15%. Three months after implementation, their available opportunity for claim resolution increased by 25%.