A multi-site home health provider that is part of a large health system in Mid-Atlantic Region.
The provider was faced with a system conversion and the challenges of trying to maintain an efficient billing and follow-up process while training staff on the functionality and day-to-day operational duties of the new system. A compounding issue for the agency was the provider was short-staffed and it was going to take a lot of time and internal resources to successfully implement the new system.
In addition, the agency also had an issue with the current AR Aging and initially assigned us to work 375 accounts with an average age of 224 days and a value of $241,000, 10% of which was aged over 360 days.
To increase cash flow and assist agency leadership in operational efficiency improvement initiatives, we utilized a team of expert claim resolution representatives to assist with billing and collection efforts. Utilizing their payer specific knowledge, the team worked each account for resolution, tracked account status and documented each action for trend identification and issue resolution. All accounts denied that could be appealed were appealed in accordance with contract terms and tracked until resolution to develop a success rate by appeal category and insurance provider for process improvement and trend identification. KeyMed Partners assisted the provider with updating billing codes, resolving legacy system claim generation issues, resolving charge description master issues, reporting trends identified for review, and payer specific contracting issues requiring resolution.
During monthly on-site meetings with the provider, we updated leadership on current issues discovered during account review and resolution. These updates provided insight into their day-to-day operations and suggestions for improving processes while transitioning to the new system.
For the original placement of 375 accounts, we collected 84% of the accounts receivable placed with us. Based on the success of the initial placement, we have continued to work with this agency to resolve all legacy accounts receivable and have maintained a consistent collection percentage throughout the engagement. We have assisted leadership in identifying an issue with their authorization process and several contract related items that required resolution to increase cash flow and clean claim submission. At KeyMed, we truly view every engagement as a partnership and we deliver results but also strive to improve the agency’s processes and support the leadership in performance improvement.