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Case Study — Customer Onboarding & Integration JS Squared Medical Group is a multi-specialty provider group spanning across multiple states in the US. They are a non-profit enterprise offering primary and specialty care services. Their largest service line is Cardiology, and they recently experienced a substantial increase in eligibility denials. The medical group understands they cannot avoid all denials, but over the past six months they have increased from $100,000 denials per month to $250,000 per month. The Cardiology group has 60 providers, 25 mid-levels, and 15 locum tenens currently on staff. They use Cerner HBO to schedule patients and collect patient payments. They recently transitioned from a centralized scheduling model to having the practices schedule appointments. The practice staff verifies the patient’s name, DOB, and address while scheduling appointments. Additionally, a new insurance plan has become available for residents in the state of California. Many residents are switching from Blue Cross Blue Shield of CA to Bear Insurance.
Objective JS Squared is looking for a revenue cycle consultant to explain how they will:

  1. Analyze current state and potential workflow gaps
  2. Provide 3 — 5 potential recommendations to help the Cardiology group mitigate eligibility denials in the future
  3. Implement strategies and tracking methods for success* There are multiple ways to approach the recommendations so please be creative in your analysis. Please note any additional information you would like to have to identify the root cause of this issue. *May not be applicable / used in the case study for a candidate with less revenue cycle experience

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