Credentialing Case Studies

Scenerio

A suboxone clinic which hardly made $10k in monthly collections was struggling with several internal issues. Changes in physician leadership and high employee turnover were instrumental. Also, they had an ambitious strategy to hire multiple NPs (Nurse Practitioners) and PAs (Physician Assistants). The aim was to provide patient services while the physician provided supervisory attention. Furthermore, the center experienced challenges with their taxonomy set-up and credentialing inconsistencies with insurances. The resounding impact of all factors was affecting monthly payments.

Solution

The AIMA team addressed the work with Medicare and then Medicaid, which opened up the HMO market for the client.

With these credentialing interventions complete, AIMA began work on the significant commercial payer contracts, for instance, UHC, Cigna, Aetna Better Health and Passport to sort out the taxonomy issues.

Once successfully enrolled with the payers, it was a straightforward task to add the new staff, as and when hired, thereby reducing the administrative demands on the physician.

The practice went on to integrate a physician owned lab (POL) which was also successfully supported by AIMA’s expert teams.

Result

A 1400% increase in revenue for the center which prior to AIMA interventions barely achieved $10k in monthly collections and now regularly exceeds $150K per month.