Guidehouse Partnership Yields New Revenue Integrity Department
In the three years since successfully implementing a new electronic health record (EHR), relationships between revenue cycle and other key leadership at a southeastern U.S.-based academic health system had become fractured. Falling reimbursement levels and a growing self-pay population combined for a significant shortfall in cash collections. Meanwhile, high revenue-generating departments experienced increasing payer-rejection volumes and preventable financial leakage in the form of denials and avoidable write-offs. Revenue cycle leaders needed to reassess their business policies and practices across the health system and re-establish the business office as an active advisory operation for the organization.
The health system selected Guidehouse to design an integrated solution addressing revenue and process improvement opportunities in both patient access and patient financial service departments. Over a 15-month period, Guidehouse rooted its team in the health system’s revenue cycle operations to help create a more effective leadership structure, filling critical functional gaps and removing ownership redundancies. The team worked side by side with departments to identify operational priorities, optimize workflows, and improve accountability through executive and department-level reporting tools. In addition to their core initiatives, Guidehouse identified specialized revenue-generating opportunities and facilitated the implementation of preferred third-party vendors, where appropriate.
The modified operational policies and system configurations led to an $8.9 million reduction in the health system’s avoidable write-offs over a 15-month period. The new standardized collection procedures for both scheduled and emergent patient populations increased pre-service collections by 53 percent. Adoption of the new outpatient cost-estimate tools, standardized prior authorization and financial clearance policies, patient-centered scripting, and standardized signage helped to hardwire the improvements across hospital and clinic services, yielding a $5.6 million increase in front-end collections.
The health system’s first outbound call campaign for patient collections was also initiated, increasing post-service collections by $2.8 million during a 13-month project period while coordinating an outsourced customer service center to provide a seamless customer-billing experience.
Management of the technical and operational integration of four specialty vendors contributed to $5.4 million in net new revenue. Finally, a new revenue integrity department was created, staffed, and trained, to include coordinating revenue management activities across hospital and physician financial service departments.