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How Pacific Cataract and Laser Institute Achieved Their Lowest-Ever Rejection Rates

How Pacific Cataract and Laser Institute Achieved Their Lowest-Ever Rejection Rates

Pacific Cataract and Laser Institute (PCLI) specializes in cataract surgery and laser vision correction. With 17 locations in 6 states and over 1,700 referring providers, the organization is regarded as one of North America’s most unique and experienced eyecare facilities.

The Challenge

Before implementing the RCxRules Revenue Cycle Engine, Pacific Cataract and Laser Institute was already operating at a high standard when it came to their clean claim rate—but they knew they could do better. They were regularly dealing with rejected claims due to minor errors introduced during manual entry—policy numbers entered wrong, incorrect insurance numbers, modifiers being missed, incorrect diagnosis codes, etc. Correcting these minor errors was a tedious and time-consuming ordeal.

“We had a higher number of rejected claims at our clearinghouse than we wanted. Our goal was to be part of the 1% club—meaning an organization with fewer than 1% of claims rejected on a monthly basis,” explained Rebecca Ashley, Data Entry Team Lead at PCLI.

Additionally, with seventeen locations across six states, any changes to billing and coding procedures had to be communicated to a large team spread out across the country. Getting everyone up to speed took significant time and effort.

Free Infographic: Overcoming Staffing Challenges

The Solution: The Revenue Cycle Engine

PCLI worked with the RCxRules team to implement the Revenue Cycle Engine and create a series of custom rules to address their unique billing and coding challenges. “Everyone at RCxRules was great to work with—very organized, very on top of things, and they found a solution for every little bump in the road,” Rebecca said.

Once the solution was implemented, PCLI began importing their 22,000 monthly encounters. The initial 90 custom rules created, in combination with the Revenue Cycle Engine’s global rules, have resulted in a 75% automation rate (meaning 75% of errors caught by the Revenue Cycle Engine are automatically corrected, and 25% are directed to coders for review).

Overcoming Revenue Cycle Management Staffing Challenges_DownloadTheInfographic.jpg

The Benefits

PCLI saw an immediate reduction in claim rejections after implementing the Revenue Cycle Engine. “We implemented the Revenue Cycle Engine in the first week of November and made the 1% club the same month, and again in December,” Rebecca explained.
They also saw a marked improvement in charge processing speed. Their staff no longer had to go in and manually add specific modifiers or correct other issues. The software catches those minor human errors and prevents things like modifiers from being overlooked. Communication across locations also improved—rather than having to detail process changes in company-wide emails, they were able to simply create rules to address new requirements.

“Since we implemented the Revenue Cycle Engine, the number of claims included in our number one rejection reason with our clearinghouse reduced from 183 in Q2 to 73 in Q4. We implemented the Revenue Cycle Engine in the second month of Q4—so impressive! And now, that issue is not even in our top 10 rejection reasons,” said Rebecca.

Find out how other large medical groups use RCxRules software to improve accuracy and boost efficiency by exploring these success stories.


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