Case Study: Stamford Pathology Group achieves restored reimbursements and reduced accounts receivable with Optum Revenue Cycle Management Services

Revenue Cycle Management Services Help Pathology Group Restore Reimbursement Cuts

Stamford Pathology Group, a five-physician pathology practice in Stamford, Connecticut, faced sudden reimbursement interruptions, payment suspensions and significant revenue loss as payers changed policies and excluded key codes. To address falling reimbursements, rising costs and declining volume while negotiating competitive contracts and optimizing claims and collections, Stamford Pathology Group engaged Optum for Revenue Cycle Management Services and Practice Management Services.

Optum implemented continuous payer monitoring, contract renegotiation, coding and claims/denial management, and custom reporting to pinpoint and resolve payment interruptions. As a result Optum helped restore reimbursement for Modifier 26 and interrupted CPT code payments, achieved an average 8.6% rate increase across commercial contracts, and improved collections metrics (Days in AR: 35; AR >120 days: 8–10%; net bad debt: 9%). Optum’s oversight and reporting also enabled faster resolution of denials and contract updates to protect ongoing revenue.

Stamford Pathology Group

Robert C. Babkowski

President