HSG was recently requested to perform an ambulatory revenue cycle assessment with recommendations for improvement for a client in the Northeast. Statistical analyses along with on-site evaluations were conducted which identified numerous factors affecting financial performance as well as patient access. Claims denials management and coding documentation and education we highlighted as two key factors negatively impacting the financial performance of the employed medical group. Through a front-end assessment and four months of onsite support, denial rates were reduced by 50% and staff were appropriately positioned and educated to manage processes effectively moving forward without outside assistance.
CLIENT QUICK FACTS
“We selected HSG to provide strategic and operational assessments of the ambulatory revenue cycle component of our small but growing practice network. Both the analytical and on-site work, along with subsequent written reports were thorough and replete with well-vetted, actionable recommendations for performance improvement and long-term sustainability.”
– Health System CEO
The employed physician network had quietly grown over the past decade without the infrastructure to support it combined with a culture devoid of communication between the facility and the professional revenue cycle components of the enterprise. Revenue cycle resources existing in the hospital setting were not available to the employed physician practices.
Data Analysis Revealed:
On-Site Evaluations Discovered:
In addition to the lack of feedback on claim delays or denials, the entity did not provide any coding support for the employed providers. Physician contracts were not updated to reflect local or national norms or to provide meaningful incentives for patient access and timely claim filing. Patient access, along with the revenue cycle woes and decreased physician and practice compensation, were all impacted by practice inefficiencies and lack of education and support.
As a result of the front-end analytics and on-site assessment of our ambulatory revenue cycle function by HSG, along with four months of onsite revenue cycle expertise support, the client was able to:
In less than six months from engagement onset to completion, the client was able to reduce preventable denials by 50%, hire coding staff to improve documentation and provide education, and most importantly was empowered to manage the situation moving forward to limit the need for outside support to overcome similar issues in the future.