When Tidewater Physicians Multispecialty Group (TPMG) began its transition into value-based care, it soon found its revenue cycle was being bogged down by a unique problem, one for which AGS Health provided an equally unique solution – Robotic Process Automation (RPA).
TPMG, based in Newport News, VA, is a network of more than 220 primary care and specialty physicians and advanced practice clinicians caring for more than 150,000 patients from 85 locations that participates in the Physician Quality Reporting System (PQRS). One requirement of the value-based contracts TPMG has entered is the inclusion of quality codes on claims submitted for services and procedures. The catch is that those quality codes have no dollar value.
Most payers were able to accept claims with zero-dollar quality codes. Some, however, could not and would automatically reject the entire claim. The simple solution was to assign a penny charge as a placeholder on claims that went to those payers. The penny, which is not paid, would then be written off and any balance due on the legitimate charges would be billed to the patient.
“Ideally, the penny would be written off automatically, But as it turns out, we developed a significant problem because tens of thousands of these penny transactions were hung up in our accounts receivable, complicating our ability to accurately bill patients. In some cases, due to the mechanics of our billing system, it stymied us from properly aging the entire visit. This one penny item sitting on an encounter basically short-circuited our normal collections processes. It prevented us from having a normal billing cycle and being able to process those transactions in a normal manner.”
The workaround was to have the revenue cycle team go into their NextGen practice management system and manually write off the penny charges. Not only did the time-consuming task take the team away from other mission-critical responsibilities, but it quickly became an uphill battle with new transactions piling up while they worked through the backlog. The resulting billing delays also frustrated patients.
Pai then recalled a presentation he had attended on RPA and realized that the penny write-off problem was a perfect fit for the technology. It was a highly repetitive, clearly definable task that, while important, did not require much by way of human judgment calls. It also delivered measurable outcomes.
To make it happen, they called upon their existing revenue cycle management (RCM) partner, AGS Health. The AGS team conducted a thorough due diligence process with TPMG to gain a full understanding of the problem before going into the design stage. This helped ensure the final RPA tool not only resolved the issue but integrated smoothly and successfully into the RCM workflow.
It took just three months from the initial discovery call for AGS Health to deliver the custom RPA tool, including design, testing, implementation, and quality assurance. It took only slightly longer – four months – for the RPA to resolve a backlog of more than 100,000 outstanding penny write-offs, something that would have cost $41,000 annually in full-time labor to accomplish.
Today, 98% of TMPG’s penny adjustment process is automated with RPA with an accuracy rate of 99%. The RPA is expected to generate an estimated savings of more than $200,000 over a five-year period. By enabling more rapid patient billing, RPA has also helped accelerate the revenue cycle, improve overall cash flow, and provide TPMG with clearer insights into its financial outlook – not to mention alleviating a significant source of customer and staff frustration.
"Our staff was definitely excited that they didn't have to do this work anymore and could instead focus on issues they knew needed their attention and expertise to address quickly and accurately. No one signs up for the job of writing off pennies in a transaction,” said Pai. “RPA eliminates that need and lets our staff dedicate themselves to the real work that they did sign on to do.”
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