A healthy revenue cycle is the most critical aspect of any business. In the healthcare industry, maintaining a margin can be incredibly challenging because of its highly regulated environment. The level of care and attention to detail can make securing payments complex, from coding issues to claim forms and reimbursements.
To meet these challenges, many healthcare organizations are turning to data and the newest solutions to support them. By collecting data from all sources, they can glean insights and streamline their workflow to reduce outstanding accounts receivable (AR) and collect the most cash in a shorter time window.
Organizations that don’t have a cohesive view of their data and automation in an industry as competitive and regulated as healthcare are at risk. They face significant drags on profit and productivity through wasted resources, lost time, and delayed payments. Plus, they miss opportunities to collaborate and improve when they can’t see the big picture.
Using cutting-edge technology solutions and a cohesive view of their data, these healthcare companies are driving higher RCM productivity and efficiency. Here is a quick look at their stories and how technical solutions improved their AR and coding.
- Organization: Academic Medical Center
- Result: 250% increase in production
As one of the premier academic medical centers in the nation, this organization focuses on pioneering biomedical research while providing exceptional clinical care and education. With a faculty of over 2,800 in 80 specialties, the center sees over 105,000 hospitalization and 3 million outpatient visits yearly.
Because the center oversaw so many patients and conditions, accounts receivable management needed help to keep up. They needed more resources to manage an inventory of $900 million and large call volumes. It cost the organization dearly: The center was losing revenue, and AR days increased.
To overcome these challenges, the medical center implemented robotic process automation (RPA) to support their staff and automate routine tasks. By automating the processing of accounts to the bots, staff members could work faster and more efficiently than ever. The center saw a 2.5x increase in production within one month of implementing the new technology, and 90% of accounts were resolved in under 60 days. It also improved work for the staff: there was a 30 to 40% improvement in training time and learning curve for all new associates.
- Organization: Leading Healthcare Business and Operational Service Provider
- Results: $1 million incremental cash flow and 40% increase in revenue capture
A sizeable leading healthcare business and operational service provider provided crucial support to hospitals and practices all over the area. Serving over 600 hospitals, 2,400 physician practices, and 37 million patients, the organization has an annual collection of $41 billion. With such a big company, leadership began to experience issues that impacted their productivity and bottom line.
Leadership experience ramp-up challenges to achieve 5.2 million charts yearly. An increasing number of clients and patients led to a growing backlog and coverage issues for the enterprise, especially on weekends and holidays. It also faced growing quality issues that led to significant revenue leakage across inpatient and outpatient care. In addition, the current setup was complex, and it had too many third parties making it complicated. The organization wanted a partner to address its challenges while minimizing the existing vendor base.
The provider deployed a comprehensive computer-assisted coding (CAC) technology to address these issues. The tool provided leadership and staff with detailed reports to monitor accuracy and productivity. The solution was scalable through health information management (HIM) training for physician coders. The organization saw the impact of the changes right away. There was a 65% reduction of discharged not final billed (DNFB) and a 70% reduction in missed procedures. The organization also experienced a $1 million increase in incremental cash flow each month and a 40% additional revenue capture.
- Organization: Mid-size Health Service Provider
- Results: 96% accuracy and $300,000 incremental cashflow
This mid-scale health service provider had over 700-bed capacity but was still financially strained. It had an increased backlog of over 1,400 records holding critical payments. Faced with increasing costs, it received inconsistent quality from domestic coders. It also had physician engagement issues that affected documentation quality and education. Leadership wanted a partner to help them clear their backlog and implement a robust coding methodology, including quality audits and an awareness program.
To face its challenges, the provider decided to conduct a comprehensive audit to understand its backlog challenges. Leveraging an in-house certified coding talent, it deployed domestic auditors to improve coding quality. The organizations also had a weekly quality governance forum combined with educational feedback.
The provider saw improvement in coding almost immediately. It experienced $300,000 incremental cash flow within eight to 10 weeks of implementing the solution. Turnaround time for new records went from 16 days to 24 to 48 hours. Plus, the organization achieved 96% and above accuracy in coding, delivering 30 to 40% cost savings across all its charts.
- Organization: Home Care Management Provider
- Result: Achieved $11 million in collections in six months
As the largest independent provider of home care management solutions, this organization has a workforce of 2,100 across more than 70 locations. The large organization struggled with billing issues resulting from denials and partial payments, including accumulating aged ARs. It also had branch-specific problems related to cash collection and delayed follow-up on denials, leading to lost revenue. Leadership wanted to partner with a company that could manage its AR portfolio with a focus on improving the organization’s processes, clearing its backlog, and meeting a stringent service level agreement.
The organization implemented three GeBBS Healthcare Solutions proprietary tools — iAR, resolution strategy, and SAAG. These tools helped leadership understand their baseline and design an execution plan. In addition, they deployed 110 in-house employees, including subject matter experts. Specifically, they sought to target high-dollar and aged accounts nearing their deadline.
The provider saw dramatic improvements after taking these steps. It achieved a 90% net collections rate and over $11 million in collections within six months of starting the solutions, which was over 30% of its total AR actuals.
These success stories illustrate how implementing technology can promote seamless workflows, improved patient care, and more revenue. The right tools can help your organization reach its full potential and meet the healthcare industry’s challenges. To see how GeBBs Healthcare Solutions can help your organization succeed, contact one of our experts today at gebbs.com.