When ApolloMD – one of the nation’s most successful clinical outsourcing firms – decided to take advantage of a low-cost accounts receivable (A/R) outsourcing option, the savings were quickly outstripped by declines in quality and productivity. It was a short-lived experiment that ended with an important lesson about the high price of missed expectations.
Atlanta-based ApolloMD, founded in 1983, is a privately held and clinician-owned group that provides emergency and hospital medicine, anesthesia, and radiology services to millions of patients each year. Backed by a network of national resources, it offers scalable multispecialty solutions for hospitals and health systems through a unique structure focused on exceptional clinical operations and enhanced patient care.
Emphasizing quality, efficiency, communication, and patient experience, ApolloMD works with partner facilities to implement best practices and process improvement and provides leadership development. It supports its clinical teams with comprehensive quality improvement and patient safety initiatives – a collaborative approach that optimizes operational backing, department/clinician alignment, and clinical quality, enhancing the patient experience.
A Lesson in Quality vs Savings
ApolloMD initially engaged AGS Health to support A/R follow-up functions, including addressing denials and unresolved cases and identifying additional revenue opportunities and solutions for permanent fixes to claim logic issues, insurance updates, etc. AGS quickly delivered upon expectations, achieving agreed upon key performance initiatives (KPIs).
However, despite outstanding results, the decision was made to replace AGS with a service provider affiliated with the EHR software recently implemented by ApolloMD. The separation was short-lived as it soon became apparent that the lower quality and productivity cost far more than any savings from the engagement.
Within six months, ApolloMD was back with AGS Health, which quickly resumed delivering on all expectations. This includes consistently achieving external quality that exceeds 96 percent for A/R functions and maintaining A/R work queue aging within 7 days of the influx date.
Rekindling the Relationship
Things between the two partners were running smoothly, with AGS continuing to provide exceptional A/R follow-up services. Soon, however, the ApolloMD was calling AGS Health to clean up after yet another vendor. This time, it was anesthesia and emergency department (ED) coding services.
In addition to poor communications with the coding vendor, “we were struggling with the accuracy of their coding and noticing missed documentation opportunities,” says Michael Lipscomb, MD, Chief Quality Officer & Regional President of ApolloMD. “We realized we need to bring in a new coding partner, so we brought in AGS and found that they just flat-out did a better job.”
That included helping ApolloMD’s physicians who were struggling to adjust to the new documentation practices required under the 2023 Evaluation & Management (E/M) guidelines – struggles that, left unaddressed, would ultimately impact reimbursement levels.
As part of their documentation improvement support, AGS and ApolloMD held weekly meetings to review documentation deficiencies that impact medical coding. It was important information that allowed ApolloMD leadership to provide targeted physician education. As a result, claims denials and time-to-bill both decreased.
Documentation improvement “is about putting out the information, circling back with the physicians and APCs (advanced practice clinicians) who are not meeting the documentation requirements, and then continuing that feedback loop. The feedback we get on our regular Wednesday calls with AGS is very helpful for figuring out which sites … need education,” said Lipscomb.
Continued Success
Today, AGS Health processes approximately 600,000 ED and 40,000 anesthesia claims annually for ApolloMD with consistently high levels of coding accuracy and quality. Its focus on documentation and coding quality has also improved RVUs at multiple ApolloMD practices, reduced claim denials, and increased reimbursement rates.
“I have absolutely zero compliance concerns with AGS Health – and compliance is paramount when we’re talking about coding and documentation,” said Lipscomb. “Secondly, from a value standpoint, the cost is excellent and behind that, the quality is very, very good.”
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