A major orthopedic medical device manufacturer faced slowing revenue collections from healthcare payers. A lack of systems and process integration also made it difficult to identify or address root causes for the rising percentage of pended claims. Adding to its costs and collections woes, the manufacturer’s field sales representatives were not gathering insurance eligibility information before distributing products. The company needed to improve collections while reducing costs. It collaborated with Cognizant's life sciences technology experts for our front-to-back office expertise and our experience in medical device revenue cycle management.
In the back office, we redesigned the client’s billing and collection processes for faster and higher revenue realization. This included taking over insurance preauthorization verification and implementing proactive appeals. In the front office, Cognizant helped field sales representatives to confirm patient benefits eligibility before they release product, which improved collection rates.
We also developed a descriptive analytics dashboard to improve payer management, using historical data to score payers based on risk of denial or underpayment. Collaborating with the client, we integrated explanation of benefits data from payer websites for quick resolution of unapplied cash.