CASE
STUDY

Primary & Urgent Care Practice Boosts Revenue with Chart Auditing, Accurate Coding, and Proper Documentation

“I’ve worked with different billing companies over the years, but I faced the same problems again and again. Aqkode addressed our coding errors, improved our Medicare Advantage risk score, and helped us build a strong practice.”

— Founder & Lead Physician
Primary & Urgent Care Facility in Tampa Bay

A thriving primary and urgent care practice, with two successful offices in Florida’s Tampa Bay metro area, treated thousands of patients and generated $1.39 million in revenue in 2021—but it wasn’t always like this!

Just a few months earlier, Aqkode’s client—a leading urgent care practice—faced billing and coding challenges that greatly impacted its profit margins.

Aqkode keeps its clients’ anonymous throughout its case studies out of respect for each provider’s privacy, but the founder and lead physician of this practice faced a common problem. He had outsourced medical billing, but he struggled to find a partner with the expertise needed to handle the complexities of Medicare Advantage coding, chart review, and fee-for-service billing. Simply put, his coding was in disarray.

Significant, preventable revenue loss

When the extent of the office’s billing issues, and the resulting revenue loss, came to light, they turned to Aqkode. They decided that the team at Aqkode was perfectly qualified to bring the practice’s RCM back on track.

Our certified billing, coding, and auditing team has spent years consulting healthcare providers, guiding them through the complex maze of medical coding and billing. After conducting a full audit of the provider’s business, we discovered the practice was losing a great deal of revenue due to:

  • Denials of service caused by general, fee-for-service coding errors
  • Costly errors caused by coding treatments at levels much lower than the negotiated rates
  • A low Medicare Advantage risk score that resulted in lower Per Member Per Month (PMPM) payments—something she would ultimately improve by training providers on proper documentation

Aqkode’s audit team conducted a thorough review of the practice’s billing, coding, and patient charts to address these problems.

Chart auditing, proper training for providers, and accurate coding

The practice used Aqkode’s chart audit because of its in-depth industry knowledge around reviewing medical charts and ensuring that each health professional documented their patient consultations. For example, the chart auditors would delve into patient test results (e.g., EKGs, blood tests). The team would then verify that all the pertinent data appeared in the charts, from diagnoses to patient consultations.

Without this information, Medicare Advantage would underestimate the office’s risk score, which would then result in lower monthly payments for PMPM patients. Given the practice’s high volume of Medicare Advantage patients, this poor risk score proved costly. Prior to extensive chart auditing, the practice’s Capitation contracts were creating a deficit, which meant they owed money to the Medicare Advantage program at the end of each year.

Aqkode’s expertise in Proper HCC coding and documentation greatly improved their risk score, thereby increasing monthly payments from the program. The chart audit team helped them reduce coding errors for fee-for-service clients as well.

With gaps identified, proper procedures established, and revenue losses greatly reduced, Aqkode is now a trusted partner for both practices and all its providers.

Detailed monthly reports and one-on-one calls

In addition to chart auditing, staff training, and proper coding, Aqkode provides one-on-one monthly calls and detailed reports that allow providers to assess the financial health of their practices. These monthly reports have data that represents the practice’s health in terms of the most common and important parameters, such as:

  • Number of patient visits per month, highlighting “no shows” and other key data
  • Month-to-month billing comparisons (outlining invoices, payments received, etc.)
  • Total outstanding invoices, grouped by aging (e.g., 30-60 days, 60-90 days)
  • Detailed breakdowns of insurance vs. patient invoices and payments
  • Monthly denials and rejections
  • Top 10 highest revenue-generating CPT codes
  • And much more!

These detailed monthly reports help guide the practice’s marketing efforts and patient follow-up, and they’re a guide to the practice’s overall growth strategy.

Results: Nearly 40% Revenue Growth from 2019 to 2021

Since Aqkode took over Revenue Cycle Management for this provider, the combined revenue for both the practices grew from just over $1 million to $1.39 million—a remarkable increase of nearly 40%.

While the provider attributes some of this increase to improvements in efficiency and increased patient volume, a significant portion resulted from proper coding and chart management.

Aqkode has helped this provider:

  • Reduce costly coding errors resulting in denials and lower payments
  • Spot billing discrepancies to recover missed payments
  • Increase insurance collections by advocating on the provider’s behalf
  • Increase monthly payments from Medicare Advantage plans

A competent RCM provider allows physicians to run successful practices without spending valuable resources on coding and billing needs. Simply put, Aqkode allows physicians and their staff to focus on what they do best—treating patients and helping them lead healthier, happier lives.

Client

 Primary & Urgent Care Provider with two offices in the Tampa Bay area

Challenges

The practice faced major revenue loss due to:

  • Denials of service
  • HCC coding errors
  • Fee-for-service coding errors
  • A poor risk score that reduced Per Member Per Month (PMPM) payments for Medicare Advantage plans

Solutions

The founder and lead physician engaged Aqkode to provide:

  • Accurate coding for both HCC and fee-for-service claims
  • Staff training to ensure proper documentation that reduced the practice’s risk score and boosted Medicare Advantage (PMPM) payments
  • Regular chart auditing
  • Comprehensive end-of-month reports and monthly, one-on-one consultations

Results

 Aqkode helped these practices achieve a nearly 40% increase in revenue between 2019 and 2021 by:

  • Reducing costly coding errors
  • Spotting billing discrepancies to recover missed payments
  • Increasing insurance collections by advocating on the provider’s behalf
  • Increasing monthly payments from Medicare Advantage plans
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