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.”