Case Study

Five-Hospital Health System in Southeastern Pennsylvania

Objective
Workers' compensation billing and collections are still as paper intensive, cumbersome, and straddled with complex state-specific regulations as they were in 1984. In this example of our Workers' Compensation Service delivery, our client, a five-hospital health system in Southeastern Pennsylvania, required assistance with resolving their workers' compensation accounts receivables (A/R). The client’s goal was to outsource their paper-based and processintensive billing and collections activities. HGS’s scope of work includes the resolution of workers' compensation and No-Fault A/R. The project began in November 1999 and is ongoing.

Our Solution
HGS developed follow-up and billing strategies based on the specialized nature of this A/R to help not only optimize collections and minimize resolution time frames but reduce the cost to collect these accounts. Five major collection bottlenecks were identified on the client’s workers' compensation A/R:

HGS’s solution addresses each of these bottlenecks:

  • Pre-billing injury verification and standardization of information collected at scheduling and registration
  • Use of HGS’s Request Tracking System to control and monitor the secure flow of medical records and other necessary documents
  • Integration of the state guidelines on underpayments and appeals into the billing and follow-up processes
  • Comprehensive capture of charges and timely report of charges to the State
  • Developing relationships with the payer and tailoring billing and follow-up processes that are mutually beneficial

Outcomes
HGS’s 16-year relationship with this provider has continued to grow, and has consistently met our client’s expectations. As a result of the work HGS performs, the client has seen:

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