A 1,400-bed, five-hospital system in the West region had recently gone through two major changes. It brought its outsourced business operations back in-house and had recently completed a large system install. As a result of these significant changes, it was experiencing cash flow issues, increased denials and significant net revenue losses due to avoidable write offs. The review of the revenue operations identified opportunities within the following key areas:

  • Pre-service account sponsorship (insurance verification and authorization)
  • Point-of-care charge capture
  • Business office process design for cash acceleration

The hospital system and Claro collaborated in structuring revenue improvement initiatives and targeting opportunities within the areas noted above. Some of the key actions during the project period included:

  • Convening a denial task force and providing tools and leadership guidance on meeting structure and focal areas
  • Focusing on system optimization areas to reduce denials, write offs and accounts receivable days
  • Designing and implementing work flows, policies, procedures and job aides to reduce unauthorized services
  • Implementing staffing realignment to better complement workloads, including job description revisions
  • Designing and implementing reporting to monitor performance at various levels in the organization (individual staff to overall system performance)
  • Implementing point-of-care charge capture improvements in surgery including anesthesia and recovery, labor and delivery, pharmacy and the emergency department

The Results

Throughout the five-month engagement, the diligent efforts by both medical group practice leadership and Claro achieved significant efficiencies and improvements within the practices and the business office, and increased consistency of overall revenue cycle operations. Highlights from the successful partnership include:

  • A 20 percent increase in upfront collections year-over-year
  • Specialty practice upfront collections improvement of 42.4 percent year-over-year
  • An 11 percent reduction in total accounts receivable to an organizational low of 32 days in AR
  • Accounts Receivable aged greater than 90 days decreased to 23 percent from approximately 30 percent of total AR
  • Increased clean claim rate to 92.9 percent (improved 1.5 percent)
  • A 10 percent cost savings related to credentialing through improved processes and vendor usage, including realigning of internal staff roles / functions