Executive Summary
As a fast-growing national chain of oncology centers with operations in over 20 states sought to accelerate growth through acquisitions, they were looking at a partner to address significant revenue cycle denials issues they were likely to get as they integrated the acquired practices.
In 2019, they turned to Access Healthcare to transform their revenue cycle operations by standardizing processes across the revenue cycle, addressing clinical denials, and improving collections. We utilized a seasoned revenue cycle team, including a strong transition team, clinical coders, denial management experts, and operations leaders to shift focus from denial management to prevention.
Further, we deployed our workflow suite to provide end-to-end management over the inventory and agent productivity. We took an iterative approach to identify root causes, communicate with client teams, and fix the revenue cycle issues. Some of the impact measures include:
Reduction in 90+ days A/R by $ 90 M
Stabilizing of 120+ days A/R from 20% to 14-16%
Improvement in clean claims submission rate to over 91%
Reduction of front-office rejections by 18% through iterative elimination of root causes and EDI work
Overall monthly collections improved by $2.8 M
Customer Background
Acquisitions are a key component of the growth strategy for branded healthcare chains emerging across the nation. Integrating acquired practices can be tricky as the acquirer can inherit many revenue cycle issues and potentially create new ones. Our client, a national oncology chain headquartered in Florida with operations in over 20 states, relied on an acquisition-led growth strategy. Because of the lack of standardized processes, revenue cycle issues such as low clean claim submission rates, high amounts of A/R, and increased days in A/R were a direct consequence of the business model.
Challenges
Lack of structured revenue cycle processes in acquired practices resulted in sub-optimal revenue cycle metrics.
The gross collections ratio (GCR) was below 34%
A/R days were above 51 days
120+ A/R was above 34%
17% below targeted collections benchmarks
The practices were losing a lot of money on coding-related denials, and the clean claim rate was below the industry benchmark
Solutions
Access Healthcare took a multi-pronged approach to streamline the client's revenue cycle. Steps taken included:
Deployment of a team of specialized oncology coders to analyze the clinical denial trends
Analysis of the A/R and denials data to identify the root causes of the revenue cycle issues
Focus on fixing outstanding denials by sharing continuous feedback with the client to prevent future denials
Focus on improving clean claim rate
Access Healthcare started analyzing the data to identify the root cause of the issues mentioned above
The plan was to improve the clean claim rate and work on 90+ insurance A/R to reduce the overall 120+ A/R by fixing claims before submission and reducing the inflow.
Results
Access Healthcare successfully transformed the client's financial outcomes from the initial transition in 2019 to mid-2021. We provide below the following results:
Improvement in A/R Metrics
Within eight (8) months, 120+ A/R was reduced to less than 20% and stabilized between the 14% - 16% range.
Overall, 90+ A/R was reduced by $15 million.
Days in A/R reduced from 51+ days to 43 days in year one and between 41 to 43 days from year two onwards.
Improved gross collections ratio (GCR) from 34% to over 38.5%
Established a framework to sustainably exceed monthly targeted collections within eight months of operations
Billing Effectiveness
Increase clean claim rate (CCR) to over 91%
Reduced front-office rejections by 18% through iterative elimination of root causes and EDI work
Bottom Line Impact
Increased insurance collections by $2,800,000+ per month
“Shifting the focus to denial prevention requires the support of front-end teams and clinicians. It takes a rigorous, iterative root cause elimination and process standardization to achieve transformational revenue cycle results. ”