Case Study: ENT and Allergy Associates achieves 82% automation of claim corrections with NextGen Healthcare's Charge Review Rules Engine

How ENT and Allergy Associates Automatically Corrects 82% of Claim Errors

ENT and Allergy Associates, the largest ear, nose, and throat practice in the U.S. with 50+ locations and over 240 physicians in the New York metro area, faced COVID-era staffing shortages and growing administrative burdens. Providers coded diagnoses while office managers and a centralized billing team reviewed and entered charges, and the practice sought ways to streamline billing, reduce manual work, and avoid hiring additional coders.

Working with NextGen, they implemented the NextGen Charge Review Rules Engine to apply payer-specific rules before charges reached the practice management system, automatically correcting errors prior to claim creation. The solution achieved an 82% automation rate (staff now intervene on just 18% of issues), eliminated labor-intensive void-and-reenter workflows, sped revenue-cycle processing, improved coding compliance, and produced cleaner A/R with fewer corrected claims.

ENT and Allergy Associates

Margaret Hargrove

Vice President, Revenue Cycle Management