The Client
Our client, a community health system located in the Midwest, has three core locations serving 119,000 residents within six counties. Having nearly 275 beds between the three locations, the health system’s patient revenue is just shy of $690 million with a total of approximately 7,000 patient discharges per year. Having several accreditations and awards of recognition, this health system is the provider of choice in their region.
The Challenge
As a result of the COVID-19 Pandemic, many health systems have been left dealing with staffing challenges due to massive turnover and a shrinking labor pool. Our client was feeling the pain of this staffing squeeze most within the claim follow-up process. Along with a depleted roster, their team’s efficiency was further hindered by an antiquated technology stack.
Utilizing a clunky and complicated EMR, much of the client’s internal process for driving claims resolution required several manual steps. The remaining revenue cycle team couldn’t keep up. In May of 2021, as the percentage of 150 day and older A/R continued to swell, the client decided to find a trusted partner that could act as an extension of their organization in capturing this older, outstanding revenue.
Utilizing a clunky and complicated EMR, much of the client’s internal process for driving claims resolution required several manual steps. The remaining revenue cycle team couldn’t keep up. In May of 2021, as the percentage of 150 day and older A/R continued to swell, the client decided to find a trusted partner that could act as an extension of their organization in capturing this older, outstanding revenue.
Our Approach
Our technology-driven approach has allowed us to analyze data, spot trends and optimize our internal workflows to drive better results on the older A/R our client nearly wrote off . Beyond the direct receipt of millions of dollars, we’ve also picked-up and created seamless continuity on many of the claims being filed on appeal.
A partnership’s success isn’t only measured in dollar and cents. At HCM, we firmly believe in delivering value through consistent and insightful communication. Our bi-weekly meetings with the client are not limited to reviewing monetary results and financial projections, but also reviewing trends being found during the resolution process. Our data team helps shine the light on upstream issues through intuitive reporting, while our client success team takes it a step further by consulting potential reasons and solutions. The last thing our clients need in this information age is another data report with no corrective action plan.
By partnering with HCM, the client added an entire roster of personnel ready to hit the ground running with decades of experience in working with all the major payers, EMRs, and Clearinghouses.
The Results
In 9 months we’ve collected $4.6 million while driving down A/R days by 10%. HCM provided feedback to prevent continued gaps within the 60-120 day buckets from capturing updated CLIA numbers to prioritizing stale denials.
Extend Your Team's Expertise With HCM
We have deep experience with all distinct payers and financial classes across every state. It’s just part of what it takes to resolve tens of thousands of claims per year for Medicare, Medicaid, Tricare, Health Shares, and commercial payers like Aetna, Anthem, and United.
Do you have aged A/R that needs to be cleaned up? We believe that one’s trash is another’s treasure. Contact us for your treasure map.
