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 approximate number 7,000 patient discharges. Having several accreditations and awards of recognition, this health system is the provider of choice in their region.

The Challenge

Since the beginning of the COVID-19 Pandemic, many health systems have been left dealing with staffing challenges due to massive turnover and a shrinking labor pool. The client was feeling the pain of this staffing squeeze most within their insurance A/R follow-up process. A lack of workforce was a problem in and of itself, but it was also shedding a painful light on another issue hindering their claims follow-up efficiency, their use of an antiquated technology system.

Utilizing a complex EMR, much of the client’s internal process for driving claims resolution required manual work and without a full roster; they couldn’t keep up. In May of 2021, as the percentage of 150 day and older A/R inventory 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 workflow to drive better results on the A/R they had entrusted to resolve. 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 isn’t only measured by dollar and cents results though. At HCM, we firmly believe in driving communication on both results being realized as well as trends being found during the resolution process. We hold bi-weekly meetings with the client to provide status updates around current month’s performance, financial projections but also trends that might indicate upstream opportunities for better overall revenue performance.

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.