Client Profile:
A general medical and surgical hospital on the East Coast with 300+ beds.
Challenge:
During the implementation of a new electronic health record (EHR) system, the hospital experienced several leadership losses, including the director of patient accounting, director of patient access, and two managers in patient accounting.
Because key leadership roles to guide the revenue cycle process were vacant, concerns were raised over the validity of the accounts receivable (AR) following the conversion. The average days in AR increased by 22 days and cash flow decreased by 17.5% within three months of go-live.
In addition, nearly 17,000 unreleased claims were identified in the clearinghouse billing system awaiting review prior to release to payers.
Solution:
McBee deployed an interim director of patient accounts, an interim executive director of revenue cycle, an interim director of patient access, and two interim managers in patient accounting to redesign the current revenue cycle structure. The interim management team focused on optimizing essential revenue cycle operations including cash posting, billing and follow up, and reporting.
The team worked closely with the hospital cash posters in providing in-depth system training, identifying system issues, and improving overall processes. As part of the focused effort, a reconciliation of the open account receivables identified payments and adjustments not posted.
To determine which of the nearly 17,000 unreleased claims needed to be billed, McBee performed a reconciliation of remits and claims to separate those already billed and paid. Those remaining claims were then placed in separate queues according to payer and assigned to the appropriate billers to resolve.
Results:
The McBee team identified $2.3 million in payments through the cash posting reconciliation. The team worked with cash posters to prioritize payments and adjustments by payer and post them to the appropriate accounts.
Within 10 months, the total unreleased claims in the clearinghouse billing system decreased by 93% to 1,200 claims. This reduction in unreleased claims allowed the department to pinpoint reasons for unreleased claims, see trends, and update edits and bridge routines within the clearinghouse.
