Health Talent Solutions: Case Study- District Hospital- Rural Rescue

The Initial Challenge

In the previous six months prior to our engaging Health Talent Solutions, our rural district hospital emerged from bankruptcy and converted from their previous system (Healthland/CPSI) to a new system at the suggestion of its management company.

As a result of this top down decision there was a lack of “buy in” by the business office staff.  Consequently, there were a number of issues during the systems conversion process:

Many staff members protested by skipping some of their allotted training  Moreover, the hospital’s electronic hand shake between their own EDI 837 remittance advice (ERA) and payer’s 835 which details payment had not been tested prior to go-live.

As a result, the district hospital’s unbilled report soon contained 83% of the hospital’s entire accounts receivable (AR).  They responded by shutting off the report because they knew they had billed these accounts.  

Compounding this was the hospital’s lack of knowledge and use of either systems’ custom report writer.

Challenges summary:

  • Coming out of bankruptcy and converting to a new financial system
  • Lack of buy in to the new system and no testing prior to go live
  • Lack of knowledge all round about the status of AR and system usage

The Resolution – Health Talent Solutions Approach

Initial Steps:

Based on our initial analysis we placed a Subject Matter Expert (SME) and a dedicated collector (who also happened to be both a coder and an registered nurse) on-site.  Our SME had extensive past experience with the hospital’s legacy and current systems, as well as their payers. 

This team took ownership of 100% of the aged receivables over 30 days from discharge date, while the hospital’s current staff focused entirely on the front end, along with clean accurate billing.

Health Talent Solutions took the lead role on resolving the EDI processes for billing. As can happen, the client mistakenly believed the unbilled was in fact billed. Although claims were technically billed, the payer never received them, therefore no payment was forthcoming.  Moreover, timely filing limits were working against them.

Within 60 days cash was 237% over the previous period

Early Results

After two months, cash was 237% over the previous period and 3 months unbilled revenue was reduced to the best practice standard of 3-7 days.

New Challenges Uncovered

The HTS contingent staff found that cash posting was incomplete. The hospital had no expected reimbursement model or matrix to gauge the accuracy of payments. Furthermore, accounts were not being moved or transferred from their original or initial financial class into their new proper financial class.  Therefore, not only was the client not perusing remaining patient balances, they were not billing any secondary and tertiary insurance carriers. 

On top of this, we found:

  • A lack of expected reimbursement preventing the efficient determination and subsequent action on both “denials” and “underpayments”
  • Explanation of benefits and remittances were not organized electronically
  • Medicare was withholding payments due to the lack of timely cost reporting and overstating of credit balances with Medicare
  • The front end (patient access / admissions) was collecting proper co-pays and deductibles on just 3 of 92 accounts sampled – that’s only 3%!

NEXT STEPS

The hospital promoted our on-site Subject Matter Expert to Back Office Manager over the entire revenue cycle including the front-end (patient access / admissions), coding, cash posting, billing and collections processes.

Additionally, working with IT we established a VPN-secure connection to two additional remote staff members, also experienced with the hospital’s systems and payers. This allowed for on-going and lower cost turn-key flexibility to the massive re-billing and secondary billing project. Moreover, after Health Talent Solutions’ engagement ended the district hospital can now quickly add proven and tested remote seasonal staff as required while maintaining a lean local payroll in their business office.

ADDITIONAL RESULTS & ACTIONS

The HTS contingent staff created an Expected Reimbursement Matrix, spreadsheets and scorecards for all roles across the entire revenue cycle, which are posted on a shared drive. They also implemented weekly revenue cycle stand up meetings for all involved employees.

The hospital finance team is also now working closely with Medicare Cost Report Consultancy to ensure future Medicare Credit balance reports are no longer over stating credits, which drove excess withholdings. Cost reporting is now accurate and timely.

All shifts (patient access / admissions) have been educated on complete processes for patient intake / registration including capturing all current insurance information, co-pays, deductibles etc. In addition, they have been trained on, assessed and assisted patients with a multitude of other payment options to include Medicaid eligibility, third party liability, victim of crime funds, and charity guidelines as appropriate.     

During the final phase of HTS’s engagement our SME mentored and trained a BOM to carry on with KPI-based scorecards and short weekly stand up meetings in order to continue to build on the accountability culture we helped establish over the course of the engagement.

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