Case Study

For over 20-years, Global Healthcare Resource has helped healthcare organizations scale operations and maximize reimbursement. Below we highlight our work with a client challenged with meeting the needs of increased volume. 

Challenge 

A leading U.S. provider quadrupled in size through multiple acquisitions and began to face frustration when scaling operations to meet the needs of increased volume. They experienced challenges collecting and maintaining a steady cash flow, specifically due to a lack of payer information as well as various payer setup issues and unclear knowledge of billing guidelines. Additionally, our partner recognized an opportunity for improved communication between billing locations post-acquisition.

Solution

Global’s team of RCM specialists fine-tuned our client’s revenue cycle processes and used the strategic approach of working through the existing payer setups, defining the requirements and creating more granular segmentation within similar but different payer plans. Global worked with commercial payers to verify requirements for coding and billing. Our team offered scalable billing outsource resources to resolve large volumes of account receivables and quickly turned cash collections around. Global also strengthened the level of communication regarding rejected claims to process and re-file them within a timely manner.

By explaining claim errors to the provider’s staff, improvements were made to their system and process functions. Global held weekly status updates with the provider to facilitate thorough communication between facilities and assisted in making the provider's check and balance process more efficient through continued training and education of the agency managers and staff. This allowed for a more accurate check of the previous month’s claims' diagnoses, payer setups, admit dates, therapies and authorizations prior to releasing the bill.

Results

Global increased collections from a monthly average of $15M to $18M, a 20% increase in cash flow. In addition, payer setups in the billing system were improved to increase the efficiency of coding, monthly billing and increased the communication of claim status during the pre-bill phase. As a result, each billing process improvement led to a more than 80% reduction in billing errors.