Case Study
Unlocking Revenue Potential with Kyla's "Care Opportunities" AI-Driven Product
Client Overview
Action Urgent Care clinics partnered with Kyla to optimize patient outcomes while increasing appointment-based revenue. Using Kyla CoPilot's Care Opportunities module, they identified missed services, procedures, and tests that could be offered to patients based on their health profiles, ensuring both better patient outcomes, patient experience and revenue growth.
Key Challenges
Action Urgent Care clinics faced several key challenges:
1
Missed Opportunities
Routine services such as Diagnostic Imaging Studies (i.e. EKGs, X-rays), and lab work were often not being offered during appointments, leading to lost revenue and missed chances to improve patient outcomes.
2
Preventive Medicine Gaps
High-risk patients, such as those with high BMI, alcohol abuse, and drug abuse issues, were not receiving necessary preventive medicine counseling services.
3
Billing Oversights
In some cases, services performed during appointments were not billed due to missed CPT code entries by providers.
The Solution
Kyla's "Care Opportunities" AI-Driven Solutions Ecosystem
Kyla CoPilot's Care Opportunities module was implemented to identify services that could be offered to patients during appointments based on their unique health conditions and identifiers. The AI-driven platform analyzed patients' medical histories to pinpoint opportunities for tests, services, and counseling, allowing providers to offer more comprehensive care while capturing additional revenue.
The Outcomes
After deploying the Kyla MD CoPilot Care Opportunities module, Action Urgent Care saw a significant increase in revenue and care navigation and optimization
General Missed Opportunities (EKG, X-rays, Labs, etc.)
Added Revenue per Appointment
$120.47
+37%
Total Potential Revenue
$216,741.09
If all 1787 missed opportunities had been addressed, the provider would have generated an additional $216,741.09 in profit.
Methodology:
By applying Average Usual Charges (AUC) for each CPT code and manually confirming missed opportunities, the Kyla AI engine identified areas where services could have been provided and optimized reimbursement accordingly.
Preventive Counseling (Dietary, Alcohol Abuse, Drug Abuse, etc.)
Added Revenue per Appointment
$65.82
+23%
Total Potential Revenue
$332,328.48
Offering counseling services to 5049 patients would have resulted in an additional $332,328.48.
Methodology:
The system flagged high-risk patients who could benefit from preventative counseling, ensuring they received the care they needed while capturing revenue for these services.
Missed Billing Opportunities
Added Revenue per Appointment
$52.40
+12%
Total Potential Revenue
$8,646.19
For 165 appointments, services performed but not billed resulted in a potential revenue increase of $8,646.19.
Methodology:
The Kyla AI Engine also identified billing oversights, such as services that were performed but lacked corresponding CPT code entries, ensuring that zero revenue was left on the table.
Conclusion
By leveraging Kyla's Care Opportunities on the Kyla MD CoPilot platform, Action Urgent Care clinics not only improved patient outcomes and experience but also realized significant financial outcomes.The Kyla AI-driven Solutions Ecosystems ability to identify missed opportunities and optimize both clinical care and billing practices made a substantial impact on the provider’s bottom line. In total, the implementation of Kyla’s solution identified over $550,000 in potential profit across missed care and billing opportunities.
Want to learn how Kyla's Care Opportunities product can boost your healthcare outcomes and revenue?
Contact us today to schedule a demo and see how our AI-driven solutions can help your practice.
