Keys To Revenue Cycle Management Success | Why Outsource?

Outsourcing Solution Saves Healthcare Provider from Smothering under Acquired Accounts Receivable (A/R) Avalanche

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As an already large medical group with 4,200+ employed and contracted physicians, serving over 750,000 patients, what do you do, when overnight through an acquisition, you gain 100 more doctors and 80,000 additional covered lives? How do you handle an A/R avalanche of this magnitude? Additionally, no one on your large financial staff is familiar with the acquired medical group’s practice management system or their revenue cycle management solution.

Since its inception this large medical group has been committed to developing innovative models of healthcare delivery that improve its patients’ quality of life while containing healthcare costs. It has been named as a top-performer by the Integrated Healthcare Association (IHA) for clinical quality, patient satisfaction and use of technology in medical care.

The group provides healthcare services to both HMO enrollees and fee-for-service patients and has contracts with most major HMOs and PPOs servicing California. Composed of more than 50 medical offices, the group is one of the largest single providers of pre-paid healthcare for seniors in California.

However, this merger and its resulting unprecedented flurry of patient A/R activity had the group’s management in a quandary, so the group’s administrators decided that its current staff would be deployed only on A/R work under 360 days, while searching for a solution to deal with the tremendous volume of older A/R. The search process was complex because finding a readily-available staff with a thorough understanding of the revenue cycle management processes and practice management systems of both medical groups can be very difficult, and it is almost impossible to hire temporary help with this kind of specific background knowledge. In addition, this was a time-consuming burden, that the group couldn’t afford, and their past experience had shown a typically low return on investment for hiring temporary staff.

After in-depth research and speaking with other providers who had faced similar challenges, the group decided to engage an outsource solutions provider that could quickly engage a dedicated team with a thorough knowledge of the legacy revenue cycle management and practice management systems. The group also wanted an outsourcing provider that could put together a team with an understanding of the claims payment process of all major insurance carriers in its demographic area, thus removing any burden of the group from having to manage the outsourced A/R work.

The medical group found its solution in GeBBS Healthcare Solutions, an Englewood Cliffs, New Jersey-based leader in healthcare revenue cycle management outsourcing solutions. Through its multiple Global Delivery Centers (GDC) located in India, GeBBS leverages its people, processes and technology to provide operational and financial solutions for its clients. To address the group’s revenue cycle management issues, GeBBS provided the organization with a team of twenty five, full time experienced revenue cycle management employees. The team manager had considerable experience with the acquired medical group’s practice management system, which was very important to the group’s administration. In addition, GeBBS Healthcare provided added value through its training of the group’s financial team members and provided them with a list of best practice tips to use in their A/R work.

GeBBS worked all the acquired older A/R to the group’s complete satisfaction and improved cash flow by reducing days in A/R and improving profitability. By identifying patient accounts that required follow-up and taking the necessary actions to collect unpaid and underpaid claims, GeBBS was also able to increase the group’s collections ratio.

SOLUTION DELIVERED

Created and trained a knowledgeable revenue cycle management team to address a large amount of patient A/R from acquisition of physician group practice.

BENEFITS

  • Rapid creation of team with experience in revenue cycle management
  • Strategic management of selected team
  • Specialized training of team members
  • List of best practice tips to optimize investment