Case Study

Today’s optimized revenue cycle management is increasingly complex for providers, who must balance reimbursement challenges and cost-effective account resolution. In 2012, one leading New England health system was in need of complete revenue cycle reengineering. The system was underperforming due to inefficient workflow processes in their financial clearance area and had a weighty backlog of accounts receivable. From the outset of the partnership, the system recognized  HGS  for our leadership, ability to optimize processes and documentation,  and  clear  direction. Based on our performance on the A/R resolution work, the client decided to expand our role by adding aged insurance A/R (insurance bad debt) portfolios to the  existing  scope  of services. This A/R was being worked by another partner and within a few months, HGS demonstrated significantly improved performance for this book of business. As a consultative partner to this client, HGS has also assumed responsibility for daily financial management reporting—a role that was nonexistent when the partnership started. HGS employs a team  of  business  analysts to provide value in a content delivery role, bringing the provider quality revenue cycle management services (RCMS)  lifecycle insights gleaned from all RCM operations. Ultimately, as a high-performance insurance A/R manager and trusted partner, HGS has turned key areas of challenge—verification, insurance A/R and account resolution—into new opportunities for this partnership.

Solution

1. Collections

Challenge

High Aged A/R Balances

How we do it:

From 2012 through 2014,  HGS’s scope of work included the resolution of non-government primary insurance A/R aged greater than 120 days. HGS employs  seasoned, talented staff, with domain expertise gleaned from nearly 20 years focused on RCM. These team members employ workflow innovation, industry knowledge, and tools such as our request tracking system (RTS) and claims management system (CMS) workflow and other best-in-class industry add-ons. 

Business Results

HGS collected more than $40 million on the goal of $30 million, a performance metric of 133% of goal. To date, we have achieved a 28% payment recovery rate on very aged receivables. Additionally as a result of the denials and process feedback we provided (in conjunction with similar efforts internally at the client), the client was able to improve their performance on the less than 120 day A/R. With HGS’s help, the client also expanded the focus area for their internal team to include all A/R less than 180 days.

2. resolution

Challenge 

Reducing a Consistent Backlog 

How we do it:

With a strong focus on identifying and fixing inaccuracies in billing and claims processing, HGS provided value-added services such as denial root cause analytics to provider staff, including Patient Access, Patient Accounting, Health Information  Management (HIM), clinical service delivery teams, and physicians and other caregivers. With these measures, HGS helped  the healthcare provider partner  maintain compliance with payer guidelines. HGS also aggressively challenged denials, looking for reversals as an activity and goal, a core resolution tactic the client had not employed previously. We also initiated daily, monthly, and quarterly reporting to bring insights to better drive higher clean claims processing to all payers.

Business Results

As a result of HGS’s efforts, the client’s resolution days decreased from 158 to 29 days, an 82% improvement.

Looking Ahead

HGS works closely with this client to provide improved cash performance, solid reporting, and useful insights into process and outcomes improvement. The client trusts HGS to deliver their inhouse health system managerial financial reporting. And HGS’s business intelligence for the client is showcased to the client’s senior leadership on a consistent basis, as we share with the client their A/R strengths, weaknesses, and opportunities. Currently, we are in discussions with the client to employ robotic process automation (RPA), and other solutions among many in our DigiCX arsenal. There is potential to build on our success for significant efficiencies with this technology.

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