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Healthcare Revenue Cycle Case Study
A community health system in the Midwest was struggling with the financial performance of its 98 employed providers. HSG provided healthcare revenue cycle on-site support related to their employed physician network in two areas:
- Full time interim leadership and management of physician network revenue cycle operations for 14+ months.
- Resources to credential new and existing providers with payers.
For the most recent quarter, net revenue for the physician group has grown from a historic average of $6.7 million per month to $8.3 million per month, an average increase in net revenue of $4.8 million per quarter, by improvement of healthcare revenue cycle processes.
Client Challenge
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.
HSG Approach
HSG led a comprehensive healthcare revenue cycle redesign. Our team evaluated performance, assessed processes that were broken, and worked with leadership to implement the new processes.
Key focus areas included:
- increasing clean claim rates by identifying billing rules with the EHR vendor,
- training and educating the entire CBO staff on payer specific billing rules,
- and addressing the credentialing issues by completing, updating, or initiating over 200 payer enrollment applications.
As a result of onsite leadership and credentialing support, accomplishments include:
- annual denials reduced by over 90%,
- days in accounts receivable decreased by nearly 20%,
- 15+ providers credentialed (previously uncredentialed for over 12 months),
- and average quarterly collections increased by $4.8 million.
Additionally, our team retrained and redefined several roles in the CBO and redesigned the workflows. This included standardization of copay collection policies and scheduling approaches. Management reporting was also developed to hold employees accountable to these metrics.
Related Healthcare Revenue Cycle Content
You can learn more by reading related content on 5 of the most common physician network revenue cycle missteps we see or read another case study where HSG supported an employed physician group in reducing accounts receivable by 20% and increasing cash collections by $2.5M in less than three months.
