Challenge

Every physician practice strives to be paid for services rendered and billed in a timely manner. In June 2016, the John Muir Physician Network was looking for a long-term cash flow solution for independent group practices supported through their Community Connect program. The San Francisco, California-area physician group needed to improve its net collection ratio and decrease days in accounts receivable (A/R). Any payments due from patients, payers, or other guarantors are considered A/R.

Solution

Guidehouse Inc. collaborated with John Muir in the backend business office, offering a billing solution that would improve revenue cycle performance.¹ By initially providing a 12-person full-time equivalent (FTE) model, with outsourced professionals making patient phone calls, taking billing calls, and following up on A/R, they began exceeding expectations and meeting the group practice key performance indicators (KPIs) within six months. In October of 2016, Guidehouse reduced the number of FTEs to seven, and eventually determined that a six-person team could meet the needs of 13 busy practices.

Actions that are driving performance results:

• Resolving denials in a timely manner driving down days in A/R
• Direct communications with each practice (daily, weekly, etc.)
• Identifying trends for practices in proper billing practices
  • Closing encounters timely to avoid filing denials and continue cash flow
  • Reporting on preventable denials that result in clean claim submissions
  • Working with practices on challenges with billing
    • Use of certified professional coders to drive accurate submissions
    • Assisting in setting up edits to capture charge review/claim edit review opportunities to see that appropriate codes are being billed
    • Educating on workflow clinical issues
• Maximizing technology to call patients with outstanding balances
• Using advanced reporting to review top KPIs
  • Days in A/R
  • Net payment per work relative value units
  • Charges
  • Payments
  • Adjustments
  • Collection ratio

Results

Guidehouse took over with 25% of the revenue in the 120-day-plus bucket on May 31, 2016, which is very hard to collect on at that time and age of the claim.

Today, Guidehouse has reduced the overall claim revenue at 120-plus days in age from 25% to 1%. This effectively doubled the amount of money aged zero to 30 days that is collected before aging to 31 to 60 days.

1. Business process management services described herein are provided by Guidehouse Inc.'s wholly owned subsidiary, Guidehouse Cymetrix Corporation.