When a three-hospital health system in southeastern Pennsylvania was in search of billing and collections for workers’ compensation and insurance accounts receivable resolution (A/R), they turned to HGS. The successful partnership, which began in 2011, has expanded to include resolution of the client’s secondary Insurance A/R, as well as additional support during acquisitions as the system grew to serve nearly 100 hospital communities across the country. This relationship has evolved—with HGS now a trusted partner for consultative solutions and design thinking, including analytics and automation projects that deliver bottom-line results for the client. As one prime example, today we provide financial analytics as a service to this client, which has undergone several major acquisitions, to help deliver business insights that have improved the client’s financial recovery on this A/R by more than 80%, while nearly doubling 30-day collection rates,
How We Do It
With a thriving partnership started in Workers’ Compensation accounts receivable (A/R), the client increasingly called upon HGS to deliver tasks that positively impacted bottom-line savings and efficiencies. A great example of this work has been meeting the client’s significant challenges with collecting outstanding claims from payers. The client knew of HGS’s success deploying analytics-as-a-service propensity models to drive end-to-end lifecycle efficiencies, for providers and payers alike. HGS conducted a deep dive of the client’s challenges to develop a model that presented insights about propensity to pay for claims, targeting a better work process, payer focus, and faster turnaround time.
HGS’s predictive model estimated and ranked payment collection likelihood by claim and payer, aiming to:
• Improve the rate of collection by guided focus based on claim
• Save effort and time spent on the overall collection process.
• Increase the amount collected and speed of recovery by prioritizing
high-value and high-propensity claims.
HGS extracted multiple features from various sources/tables to create the predictive model. Model features addressed claims characteristics such as patient demographics and payer detail, service providers within the hospital, payer payment and transaction detail, claim duration, and follow-up duration, and detailed denial information from HIPAA 835 files.
Before HGS’s deployment of this model, the client was collecting approximately 11-15% of payments on a monthly basis. HGS now collects 15-20% of funds owed to the provider on a monthly basis as a result of using this model. The additional gain comes from reduction of days sales outstanding (DSO) for those claims with higher collection opportunity. The faster turnaround time and decreased claims loss ratio have resulted in an enhanced 30-day collection rate. Due to increased cash and faster collections, the client views HGS as a provider of real outcomes.