Effective Intelligence Solutions Drive Workforce Optimization and Incentive Based RCM at Strategic Practice Solutions 

CASE STUDY: Incentive-Based RCM at Medical Billing Company

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Since deploying RCM Workflow Automation, SPS has achieved notable outcomes for its clients in terms of bottom-line performance with fewer employees.

Attract and retain the best-of-the-best in billing staff

Strategic Practice Solutions (SPS) provides medical billing and practice management consulting and services to specialty medical practices. Founded in 2010, the New Jersey-based company has refined a replicable process for collecting revenue for specialists by maintaining efficiency and integrity, as well as hiring the best and most experienced people to work on the accounts. SPS offers support in all areas of revenue cycle management (RCM) and looks at each practice and organization holistically, providing advice that supports a clean, streamlined and profitable workflow.

Remote workforces bring their own unique sets of opportunities and challenges. Like many organizations, SPS found itself needing to effectively manage a fully remote workforce in 2020 as the COVID-19 pandemic shuttered many office doors. Since that time, remote workplace models have become increasingly mainstream as workers seek better work-life balance and competition for qualified billing staff has reached a critical level. One of the key value propositions of SPS is its ability to attract and retain the best-of-the-best in billing staff. Consequently, executives needed visibility into the daily work effort of all staff and a framework of data that could reveal who the top performers were and where shortfalls were occurring. Executives also needed tools that could help staff become more productive through guidance that would ensure daily activity produced the most return on investment (ROI).

At a time when its client base—specialty physician practices—face declining reimbursement and tighter operational margins, making the most of available staff resources was simply paramount. SPS executives needed a level of analytics and data granularity that EMRs and practice management systems are not able to deliver. According to SPS President Kristin Callaway-Kelly, the company needed effective ways to incentivize billing performance through insights into key questions such as:

Workflow automation to monitor the activity of a remote workforce on a daily basis

Following a long-standing partnership of more than 13 years built on trust and best in class support, SPS turned to its technology partner MedEvolve and deployed the vendor’s Effective Intelligence solutions that include RCM Workflow Automation and Revenue Cycle Analytics. SPS had already benefitted from MedEvolve’s practice management platform and its flexibility to integrate with more than 40 different EMRs—capabilities that have made it extremely easy for SPS to onboard new clients.

MedEvolve’s workflow automation solution provides the needed level of intelligence to monitor the activity of a remote workforce on a daily basis, ensuring that staff are not only productive but also effective in their work. By tapping into AI and machine learning, MedEvolve’s software ensured claims are prioritized so staff know which ones to work first. Workforce automation essentially guides staff to tasks that have potential to produce the most ROI, rather than staff wasting time on claims need little to no attention. Notably, 80% to 90% of open claims typically do not require attention on a daily basis. RCM Automation also tracks every action taken to resolve a claim, including communications between clients and staff members, to identify exactly how much work is being done on every claim. Having lean and effective talent pool reduces the company’s overall cost to collect, which is already being impacted by thinning margins of their provider client base. The ultimate goal is a high zero touch resolution rate whereas claims require no human intervention post-coding.

Real-time revenue cycle analytics to effectively communicate results to clients

SPS also benefits from MedEvolve’s Revenue Cycle Analytics, providing executives with real-time access to Key Performance Indicators (KPIs) and specialty-specific benchmarks. Callaway-Kelly appreciates access to prescriptive scorecards of revenue cycle trends that help clients answer key questions related to financial health, identify negative patterns and trends, view monthly comparisons and benchmarks and simply make better decisions.

The insights provided through the score cards are so valuable. If our clients don’t receive it on time, they ask for it. It has definitely differentiated SPS from our competitors in terms of our ability to identify opportunities for process improvement without the need to comb through massive amounts of data.

Kristin Callaway-Kelly, President, Strategic Practice Solutions

Effectiveness data for each employee enables SPS to implement performance-based incentive opportunities

Visibility into daily activity allows Callaway-Kelly to better understand the effectiveness of billing staff, identify opportunities for improvement and hold staff accountable.

Having both productivity and effectiveness data available for each employee has also enabled SPS to implement performance-based incentive opportunities. One creative opportunity Callaway-Kelly devised involved gamification. A day-long contest was held to see which employee could achieve the highest number of “quality” claims touches. This way, employees were ranked according to how much they could contribute to the bottom line. First and second-place winners received $100 and $50 Amazon gift cards respectively.

“Everyone participated. It was like watching a horse race throughout the day,” said Callaway-Kelly. “We were surprised at who won and who fell off. People were very motivated, and the contest literally broke the threshold of what employees thought they could achieve.”

SPS learned a lot about its staff from the contest, and plans are in place to conduct similar opportunities on a more regular basis. Without a foundation of effective intelligence, Callaway-Kelly acknowledges that incentive-based revenue cycle would not be possible.

As a partner, MedEvolve is more like a family to us, honestly. The level of support and guidance is one of the most valuable aspects of our relationship. When I need something, it gets done. I’m very appreciative of MedEvolve’s deep expertise and the ongoing interaction with their team.

Kristin Callaway-Kelly, President, Strategic Practice Solutions

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