Disaster Averted. Hospital Credit Balances Resolved

GeBBS has maintained a team of 150+ experienced analysts specialized in resolving credit balances since 2010 resulting in 30% cost savings.

Client: A large RCM company servicing over 4,400 hospitals and physician groups nationwide.

Challenge

• Company acquired contract from a hospital, with over $123 million in A/R
• Over $32 million in credit balances
  • Incorrectly posted payments
  • Patient overpayments of over $3.75 million – Contract manager issues
  • Compliance risk due to credit balances not resolved in a timely manner
• Credit balance accounts growing at an alarming rate
• Distorted A/R due to unresolved credits
• Instant requirement of reducing credits from $32 million to under $15 million

The GeBBS Solution

GeBBS has maintained a team specialized in resolving credit balances since 2010. The team is comprised of highly-qualified individuals with a hospital accounting background and strong analytical skills. As part of the implementation, an experienced GeBBS transition manager was deployed on site to understand the clients existing workflow. A team of 18 FTEs were assigned to analyze the credit balances and identify root causes.

Highlights of the solution include:

• Detailed study of credit balance accounts and payment posting processes • Review of ERS rules engine on the client’s billing system and process improvements
• Account balance based resolution strategy implemented
• Patient credits moved to outstanding patient accounts
• Incorrect contractual adjustments reversed
• Unclaimed property worth $4.5 million adjusted within three business days

Results

• Credit balances reduced from $32 million to $15 million in 45 days
• Process improvements made to prevent new credits
  • Replacement of contract manager to ensure correct contractual adjustments
  • ERS rules engine updated to prevent automated posting that would create new credits • Further reduction from $15 million to under $6 million in 90 days
• Old credits over six months resolved on priority
• Compliance risks mitigated

GeBBS credit balance analysts are among the most experienced revenue cycle consultants in the industry. They undergo a rigorous selection and training process to ensure they can handle complex credit balances cases.

Key Features of GeBBS’ Solutions

• 150+ experienced credit balance analysts
• 30% average cost savings of managing credits
• Secondary billing opportunities
• Increase compliance
• Increase profits
• Scalable: quick ramp up, flexible deployment models
• Focus on process improvement: prevent new credit balances