CLIENT QUICK FACTS
Health system executives came to HSG with significant revenue cycle and payor credentialing issues within the employed provider network. Collections for the group were declining and nearly 20 providers had not been credentialed by payors, preventing the group from billing for their services.
Key focus areas included: 1) Increasing clean claim rates by identifying billing rules with the electronic health record (EHR) vendor; 2) Training and educating the entire central billing office (CBO) staff on payer specific billing rules; and 3) Addressing the credentialing issues by completing, updating, or initiating over 200 payer enrollment applications. More specifically, HSG provided on-site support in two main areas:
HSG led a comprehensive revenue cycle redesign. Our team evaluated performance, assessed processes that were broken and worked with leadership to implement the new processes all focused on improvement ambulatory revenue cycle performance.
As a result of onsite leadership and credentialing support, accomplishments include:
Additionally, our team retrained and redefined several roles in the CBO and redesigned the
This included standardization of copay collection policies and scheduling approaches. Management reporting was also developed to hold employees accountable to these metrics.