Client Profile:

A multi-facility skilled nursing organization dedicated to serving patients in the Midwest.

Challenge:

As the saying goes: “Cash is King”. Maintaining a steady cash flow is one of the pervasive issues that affects many health care providers, especially in a time when economies of scale are rapidly transforming the landscape of health care. The skilled nursing world is no exception. Organizations attempting to go through transitionary phases such as process realignment and systems implementation are especially susceptible to reduced cash flow, both during and following these transitions.

A large skilled nursing provider had recently grown to more than 35 facilities across multiple states and was met with frustration when trying to scale operations to meet the needs of increased volume. The provider experienced challenges collecting and maintaining a steady cash flow.

Specific challenges nested within the provider’s operations included a lack of payor information, various payor setup issues, and unclear knowledge of billing guidelines. Additionally, the provider recognized an opportunity for improvement in communications between billing locations post-acquisition.

Solution:

McBee’s team of highly experienced skilled nursing revenue cycle specialists fine-tuned the revenue cycle process and took the strategic approach of working through the existing payor setups, defining requirements, and creating more granular segmentation within similar, but different payor plans. McBee worked with commercial payers to verify requirements for claims and billing. Our team offered the scalable billing outsource resources to resolve large volumes of accounts receivables and quickly turned cash collections around.

McBee also strengthened the level of communications regarding rejected claims in order to process and rebill them within a timelier manner. By explaining claim errors to the provider’s staff, improvements were made to their system and process functions.

McBee held weekly status updates with the provider to facilitate thorough communication between facilities and assisted in making the provider’s Triple Check Process more efficient through continued training and education of the facility’s managers and staff. This allowed for a more accurate check of the previous month’s claims’ diagnoses, payor setups, admit dates, therapies, and authorizations prior to releasing the bill.

Results:

By the third month of the engagement, McBee had increased collections from a monthly average of $18M to $21M, a 17% increase in cash flow.

In addition, payor setups in the billing system were improved to increase the efficiency of monthly billing and the Triple Check Process increased the communication about claim status during the pre-bill phase. Both of these billing process improvements led to a more than 80% reduction in billing errors.

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