Health Talent Solutions: Case Study

How Revenue Cycle Management Saved A Hospital’s CapEx Projects from being Sidelined

The Initial Challenge

A rural hospital was struggling with their cash flow and a growing accounts receivable despite a looming capital expenditure project to expand the hospital. They were also facing a go live on a new IT system in just three months’ time. The hospital needed rapid cash acceleration to both pay for and prepare for the upcoming expenditures.

Of the hospital’s total accounts receivable, nearly 37%, was aged more than 90 days from discharge date – something needed to be done. Our best practice standard established from working with dozens of hospitals over the years, no more than 20% should be aged beyond 90 days.

In addition to enabling immediate cash flow, the hospital was committed to improving their long-term financial performance via improved process and procedures. While they had an interim business office manager in post and efforts had been made to manage third party billing, no proactive follow up was happening, resulting in further unpaid accounts.

With a systems conversion looming, resolving the backlog in a reasonable time frame and migrating clean data and accounts was of critical importance.

Challenges summary:

  • New CapEx projects requiring an immediate injection of capital within a 3-month timeframe
  • Significantly aged outstanding accounts receivables with more than 37% 90 days in age or greater
  • A system conversion project requiring clean accounts and data

The Resolution – Health Talent Solutions Approach

Initial Steps:

Health Talent Solutions worked with the hospital to outline the strategic approach, which included assigning a Subject Matter Expert (SME) on-site as well as an additional off-site professional to address both budgetary considerations and access to talent. This team took ownership of 100% of the aged receivables over 30 days from discharge date, enabling the hospital’s business office staff to prepare for the systems conversion.

In resolving aged third-party accounts, the on-site team had access to UBs remittances, medical records and other documentation needed to maximize recovery resulting in higher cash collections and faster third-party account resolution. It also resulted in better patient, physician and community relations as well as minimized burden on existing staff to support the project.

Health Talent Solutions held standing monthly conference calls to review results, provide recommendations, address issues and feedback as well as develop forward-looking roadmaps.

Within 45 days, cash was 148% over the previous period

Early Results

After two months, just 16% of the AR was over 90 days in age, representing a significant improvement, which exceeds HFMA MAP High Performance 90th percentile Award Winners.

New Challenges Uncovered

The HTS on-site contingent staff found cash posting to be incomplete. The hospital lacked a current expected reimbursement model or matrix on which to gauge the accuracy of payments, during the payment posting process.  As a result they were not properly addressing contractual underpayments. 

On top of this, we found:

  • A number of unpaid claims from patients residing is one particular neighboring state
  • Explanation of benefits and remittances were not organized electronically, exacerbating an effective solution to properly appealing contractual underpayments.

NEXT STEPS

We helped the hospital secure a full time business office manager with strong past experience with their payers and new McKesson Paragon System.  We created an automated filing system for payment remittances, which facilitated the necessary team work to address underpayments and denials.  This allowed us to discover a historical thread of underpayments from the hospitals largest payer.  We also applied for a Medicaid Number from the neighboring state.

ADDITIONAL RESULTS & ACTIONS

Over the remaining months a significant positive cash flow was recovered from zero balance accounts. We also recovered additional revenues from out-of-state Medicaid.  HTS trained all front end shifts on proper patient financial screening and intake, adding monthly scorecards which became part of the employee rewards and evaluation process for patient access.  

During the final phase of HTS’s engagement we celebrated with team building exercises to enable future communication, teamwork and accountability. We also favorably renegotiated their self-payout sourcing agreement and updated their charity care guidelines.   This transformation lead to both a successful Joint Commission Survey and Systems Conversion, with the hospital having four times the amount of cash on hand at the conclusion of the project.

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