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The Resource We Needed to Reduce Workload and Increase Revenue
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Brooke Hawley
Owner of Maple Grove Pearle Vision
As the number one grossing single location in the Pearle Vision network, we do approximately 650-800 exams a month and have five full-time doctors. We accept the majority of medical and vision plans with only about nine percent of our patients being private pay, so the vast majority of our exams require reimbursement from insurance companies.
If your accounts receivables are lagging, profitability can be significantly impacted. When faced with this problem in 2021 with such a high volume of patients and insurance processing, we knew we needed to seek out an industry partner we could rely on to keep us on track. We were fortunate to discover HELIX’s RCM, a service that has improved how efficiently and accurately we are able to manage our billing, and ensures we get reimbursed in a timely manner for our services.
When looking for a partner, we knew we wanted to have personalized service, which RCM gave us by assigning us one representative, Lindsay, who has in-depth knowledge of our account. We are a large-volume office, and many other companies did not have the resources to handle our needs in the way HELIX has. Lindsay’s expertise and active engagement have enhanced our team’s billing competencies. The clear notes provided by RCM on patient accounts, streamline our responses to customer inquiries, mitigating extra work by our team members to address these questions.
We recently became in-network with VSP. Anytime you add a new insurance it can be very stressful for the team, and with Lindsay’s aid, it was a smooth process. She helped to alleviate the stresses we were feeling about how to do things properly and helped guide us through understanding how VSP benefits work. She has also been great at identifying trends in our claims.
Internally, we have created strong policies for how we make appointments. This includes how we collect the information from patients, how we verify insurance and the continued training we do with staff. We work with Lindsay to identify key areas where we need additional training to ensure we are billing correctly. Lindsay meets with us weekly to review our accounts receivable. Vision payers that have not paid after 30 days are given a closer look and additional management by RCM. We do not let any claim remain unpaid for more than a reasonable period – medical is 60 days.
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Not having to worry about claims being processed and payments being posted on time gives us time to focus on running our business in an efficient way. RCM takes care of everything related to claims, posting and managing accounts receivable, and they keep us updated on the status of our claims.
They are transparent with us, providing notification in a timely manner of things we need to fix or need our attention, and they provide us with insights into the status of our claims through easy-to-read reporting. Powered by HELIX’s RCM, our claims are billed to insurance within 24 hours, and our payments are posted within a few days of being received.
We serve our patients with a higher level of customer service because we are billing insurance correctly, thanks to the help we are getting from HELIX’s RCM. Most of our patients don’t understand their benefits or what their EOB says when they receive it. With RCM managing our insurance, we are able to give better explanations, providing them with information when their claims are not paid. It allows us to focus on the customer experience rather than tracking down insurance payments.
Year-to-date, RCM has helped us file and expedite 3,079 claims. RCM also successfully collects insurance receivables within 60 days. The biggest ROI of using HELIX’s RCM is having the peace of mind that our claims are being handled in a timely manner, being managed for us when there are rejections, and having clear communication with our account rep. We can rest easy knowing RCM has our back, ensuring our practice is reimbursed as consistently and swiftly as possible.
Revenue Cycle Management is the process of submitting a claim for reimbursement from beginning to end. When done properly, your office can increase payments while decreasing bad debt write-offs. Our team handles virtually every aspect of the billing cycle for you. You pull the benefits and assist with missing claim information and we take care of the rest.
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