Revenue Cycle Management

The client.

A 400+ bed community hospital located in the Southeast.

The business issue.

This hospital experienced tightening margins due to external market pressures. At the same time, it recognized opportunities to improve internal revenue cycle processes and revenue management.

The solution.

The hospital engaged The Claro Group to conduct a comprehensive review of its revenue cycle as a means of identifying opportunities and developing a plan for improvement.

Members of The Claro Group teamed with hospital personnel to identify opportunities across the revenue cycle, including more than $10 million in net revenue improvement and significant cash acceleration opportunities related to:

• Accounts receivable clean-up
• Time-of-service collections
• Managed care contracting

The Claro Group then teamed with the hospital to prioritize these opportunities and begin implementing solutions across several areas:

• Time-of-service collections
• Managed care/commercial underpayments
• Self-pay management

The team currently is developing implementation plans to address opportunities identified within APC/charge capture and DRG/documentation improvement.

The results.

This approach has generated substantial benefits for the hospital:

• An increase in time-of-service collections of more than 45 percent.
• A 20-percent increase in the self-pay recovery rate for collections after the patient visit.
• Implementation plans for the recovery of over $2.5 million annually in net revenue associated with DRG/documentation improvement and APC/charge capture.
• A robust reporting mechanism for monitoring self-pay collection.
• A new infrastructure for identifying and recouping managed care/commercial underpayments.