Executive Summary
Acquisitions are vital for the growth of branded healthcare chains nationwide. However, integrating acquired practices often brings inherited revenue cycle issues and potential new challenges. Our client, a national oncology chain based in Florida with operations in over 20 states, aimed to accelerate growth through acquisitions. They needed a partner to address significant revenue cycle denial issues that could arise during the integration of acquired practices.
The oncology chain turned to Access Healthcare to transform their revenue cycle operations by standardizing processes, addressing clinical denials, and improving collections. We assembled a seasoned revenue cycle team, including a strong transition team, clinical coders, denial management experts, and operations leaders to shift focus from denial management to prevention.
We deployed our workflow suite for comprehensive management of inventory and productivity. Our iterative approach involved identifying root causes, communicating with client teams, and resolving revenue cycle issues. Some of the impact measures include:
Reduction in 90+ days A/R by $ 90M.
Stabilizing of 120+ days A/R from 20% to 14%.
Improvement in clean claims submission rate to over 91%.
Reduction of front-office rejections by 18% through iterative elimination of root causes and EDI work.
Overall monthly collections improved by $2.8M.
Challenges
Lack of structured revenue cycle processes in acquired practices resulted in sub-optimal revenue cycle metrics.
Gross collections ratio (GCR) was below 34%.
A/R days above 51 days.
120+ days A/R above 34%.
17% below targeted collections benchmarks.
Practices lost money on coding-related denials, and the clean claim rate was below the industry benchmark.
Solutions
Access Healthcare took a multi-pronged approach to streamline the client's revenue cycle. Steps taken included:
Deployment of a team of specialized oncology coders to analyze the clinical denial trends.
Analysis of the A/R and denials data to identify the root causes of the revenue cycle issues.
Focus on fixing outstanding denials by sharing continuous feedback with the client to prevent future denials.
Focus on improving clean claim rate.
Access Healthcare started analyzing the data to identify the root cause of the abovementioned issues.
The plan was to improve the clean claim rate and work on 90+ days A/R to reduce the overall 120+ days A/R by fixing claims before submission and reducing the inflow.
Results
Access Healthcare successfully transformed the client's overall financial outcomes. Below are the results:
IMPROVEMENT IN A/R METRICS
Within eight (8) months, 120+ days A/R was reduced to less than 20% and stabilized between 14%.
Overall, 90+ days A/R was reduced by $15 million.
The total days in A/R were reduced from 51+ days to 43 days in year one and down to 41 days from year two onwards.
Improved gross collections ratio (GCR) from 34% to over 38.5%.
Established a framework to exceed monthly targeted collections within eight months of operations sustainably.
BILLING EFFECTIVENESS
Increased clean claim rate (CCR) to over 91%.
Reduced front-office rejections by 18% through iterative elimination of root causes and EDI work.
Bottom Line Impact
Increased insurance collections by $2.8M per month for an annual boost of over $33M.