Work record / Operating / Sublime Medical

Sublime Medical: claims were failing at the code, not collections

The whole building called it a collections problem. I followed one denied claim back to where it began, and the fault was in the billing code at submission.

The seat

In 2015 I took the fractional COO seat at Sublime Medical. It was my first fractional seat, and for four months I ran the practices day to day. The group is in Southern California, and the work ran through Common Ground.

Sector	Healthcare services (multi-practice medical group)
Type of work	Revenue cycle and operations turnaround
Where	Southern California
Years	2015 (four months)
How long	Four months
Through	Common Ground
Credits	Common Ground Jesse Fowler, Fractional COO

What I was brought in to decide

Sublime Medical is a California group offering cosmetic and medical dermatology. It started in Riverside and grew to three offices covering the Inland Empire and Orange County. Today it practices under the name Sublime MD.

By 2015 appointment books were full and the patient base kept growing, but cash collected trailed revenue earned. How I put it at the time: a very good provider running a very sloppy practice. Inside the building, everybody read the gap as a collections problem. The usual answers were to push harder on collections, hire another biller, or send billing to an outside firm.

What we did

I took the fractional COO seat, my first, to run the practices day to day for four months.
My first step was to rule out demand. If schedules are full, the shortfall is not about volume.
Alongside the billing lead, I traced one denied claim in reverse, starting from the payer's rejection and ending at the chair where the procedure took place. The defect was at submission, in the billing code. Follow-up was not the issue.
Three things made the codes stale. The practice ran on a software tier that carried no updates. It had never purchased the plugins that do. And its setup had never been completed. Nobody owned the question.
I kept the repair at the same level as the defect. The practice moved to the correct software tier, set up properly, and the codes were corrected. One named person inside the office now runs a weekly check that every code in use is current. We added no new platform, no new hire and no outside billing vendor.
We rebuilt the office paperwork together with the people who use it. We also wrote down a clear line between staff and practitioners on the business side.
From the first week, someone inside the office owned that weekly check. It was already running without me by the time my seat ended.

Results

Insurance billing climbed 42 percent month over month by the fourth month.
When my seat ended, the practice carried on with the weekly code check and the rebuilt paperwork system.
Paid claims went up with the same patients, the same procedures and the same billing staff, because claims stopped failing before a person ever looked at them.

The lesson

Repair the problem at the level where it occurred. Chasing a collections problem harder often means a paperwork problem nobody has found yet.

Public record

Stories from this work

Everyone called it collections. It was maintenance.A dermatology group's missing revenue looked like weak collections. It was out-of-date billing codes and a broken paper trail.Origin: Sublime MedicalMy first fractional seat: a back office that could not turn full schedules into cash.

Firm record

Common Ground keeps its own account of this engagement: Sublime Medical on the Common Ground wiki.

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