RP Sanjiv Goenka Group

Referral hospital improves Medicaid revenue by 60% with accelerated claims approval

The challenge: Improve patient peace of mind while increasing hospital revenue

Our client, a major referral hospital, serves a predominantly uninsured and underinsured patient population. Having no health insurance or being uninsured means that people often postpone essential care or forego preventative care. Delaying care is a downward spiral that often leads to unnecessary hospitalizations and medical debt.

The hospital’s RCM leaders saw an opportunity to improve both health and financial outcomes by offering financial advocacy and support to patients early in the care delivery process. But the lack of a streamlined patient Eligibility and Enrollment workflow across multiple centers of excellence – Heart Care, Cancer Treatment, Women’s and Children’s Services and Senior Services – created a black hole and impeded the process. At the same, the hospital was also witnessing a staffing shortage, further compounding the challenge. So, they turned to Firstsource for help.

The solution: Reimagining patient eligibility and enrollment with tech-enabled processes

Firstsource deployed its proprietary Advocacy Services solution to design and support the Patient Eligibility and Enrollment process for its uninsured and underinsured patient population.

A tailored approach was vital to success. Our experts designed custom eligibility, enrollment and staffing workflows to enhance efficiencies for each of the hospital’s four centers of excellence —  encompassing cross-functional team touchpoints and personalized patient engagement models.

The customized workflows were built to create end-to-end claims visibility. It also provided patients with pricing transparency — a clear assessment of their out-of- pocket expenses and connect them to alternative funding sources to ease their financial burden.

The results: Faster claims processing and pricing transparency to advance public benefits

The Firstsource Advocacy Services helped with loading coverage, dropping claims, and monitoring the entire eligibility process. The solution seamlessly connected the hospital’s patients to public medical benefits, helping them get an accurate assessment of their out-of-pocket expenses and identify alternative funding sources. This resulted in peace of mind for patients and 42% increase in Medicaid referrals within a year.

The hospital benefited through lower uncompensated care costs and bad debts with and saw a 60% increase in Medicaid revenue in six months.

Business impact

60%

Increase in Medicaid Revenue in Six Months


42%

Increase in Medicaid Referrals within one year


Improved

Patient Experience

 

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