The challenge: Reactive approach to revenue management triggers denial downward spiral
At US Health Memorial Craig, denial claims were exceedingly high and cash levels were dangerously low. Like many small, rural hospitals, the Memorial Hospital at Craig was struggling to find and cultivate experienced staff to deal with denials effectively and efficiently. The CEO, who we had a long-standing relationship with, knew they needed outside help to rein in runaway uncompensated care rates.
The solution: Create a culture of excellence in revenue cycle billing
Firstsource employed its elite Denials Analytics team and advanced technology to review all CARC and RARC codes received over a year to quantify and stratify the results. We discovered that 20% of patients overall who declared self-pay actually had some sort of insurance coverage Once our audit was complete, we worked with the CEO and his team to create a training ground for staff to learn best practices for revenue cycle billing, that included
- A communication network between the front-end staff – registrars and physicians/nursing staff – all the way through to the back-end staff – coders and billers – so that each division understood how they all interact and help to increase total cash on hand.
- Productivity standards — such as addressing 50-60 denials per day—which helped staff to learn why denials were happening and renegotiate contracts for better outcomes.
- Automated payment posting to reduce time and preserve resources.
Results: Total revamp of the revenue billing lifecycle frees cash
The hospital has experienced a dramatic reduction in cash leakage and days it takes claims to get paid. But, most importantly, hospital staff are empowered with the latest tech and processes to manage the entire revenue billing lifecycle.