Our client is one of the few independent, community-based, providers of integrated addiction treatment and primary care services in the United States, serving New Yorkers with substance use disorder who are disproportionately low-income. Without the resources of major healthcare systems, many independent providers had faced challenges with New York State’s Medicaid redesign transition, as they had gone from billing most of their services through a single-payer (the State) to billing around ten different managed care payors. Our client estimated they had lost 5% in revenue during the transition, an amount that was the difference between operating surplus and loss for this non-profit organization. They were also implementing a new electronic health record system. The CEO hired Anoteros to evaluate the end-to-end revenue cycle process and provide recommendations for improvement.

We assembled a team with a mix of expertise in provider billing, payor claims processing, and healthcare technology. To understand all aspects of the revenue cycle we met with staff from finance, IT, and clinical departments as well as the third-party billing vendor, reviewed service and billing data, and assessed the relevant capabilities of both the clinical electronic health record system and the billing system. We took a methodical approach to assess the current process and systems, identify the gaps, and use that analysis to inform recommended actions. Recognizing that “every dollar counts” we did not wait until the final report to share our recommendations, ensuring that leadership was informed immediately when we found a significant issue, so that adjustments could be made in the current billing cycle.

The client did not have the resources of a major provider system, so we placed a lot of importance on ensuring our recommendations were realistic, actionable, and prioritized. Our work provided the client – and their Board – with a comprehensive understanding of the gaps and issues in their current process and enabled them to take a step-by-step approach to address the issues over the following months.