Challenge

A premier pediatric hospital on the West Coast had earned accolades for leveraging its electronic health records (EHR) to improve patient outcomes, customer satisfaction and financial stability. However, a new revenue cycle framework complicated accounts receivable (AR) and cash flow management. Unbilled claim backlogs were growing and AR was at an all-time high. Uncollectable and bad-debt write-offs were becoming more frequent, staffing levels had not grown with patient volume and EHR technical issues were delaying collections. Policies and procedures for staff were outdated and not uniformly followed, and coordination between revenue cycle divisions was often missing.

The hospital engaged Accenture to transform its revenue cycle, with goals of providing stability and funding further improvements to patient care by leveraging technology and leading practice adoption.

Strategy and Solution

The strategy began with a comprehensive assessment of the revenue cycle across scheduling, patient access, financial counseling, billing, collections and IT. The team found unfinished tasks, unclear documentation and unrealistic productivity expectations across the areas. Staff had difficulty completing their daily work due to technical configurations that created unnecessary steps and workarounds.

Road map to success

The team created a road map for the hospital’s Revenue Cycle transformation that centered on the following elements:

Quick wins

Prioritized accounts, appealed high dollar denials, created reports to highlight accounts needing attention, ensuring all accounts reach a work queue.

Staffing analysis and organizational structure

Conducted volume-based staffing analyses, realigned manager-to-staff ratios, redefined policies, processes and job descriptions.

Leading practice adoption and EHR workflow redesign

Deployed EHR automations, interim billing, coverage management and charity evaluation. Refined billing and claim edits and authorization workflows.

IT governance

Created issue management processes, clarified requirements for new ticket entries and increased ticket status transparency.

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Transformation

Three months into the project, the hospital had its most profitable month in history, surpassing its cash collection target by 30 percent. Staff expressed enthusiasm about clear, documented priorities and expectations. Managers were grateful about increased communication with and understanding of other areas. Tickets completion increased by more than 50 percent. The project’s financial success continued through project completion, resulting in the outcomes below. The hospital continues to work with Accenture to help improve other processes and areas.

Positive results

The team focused on quickly reducing unbilled claims to inject cash into the organization.

11M

Surpassed cash collection goal by more than $11M.

45%

Reduced unbilled claim backlogs by 45 percent.

24%

Reduced outstanding denials by 24 percent.

20%

Reduced total AR by roughly 20 percent.

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