Transitioned billing from hospital and increased revenues

Situation

A partnership of board certified emergency medicine physicians employing a team of advanced practice nurses exclusively serve the emergency room of a 152 bed facility owned by Adventist Health serving a three county area in the State of California. The hospital supported the group by providing revenue cycle management services through its business office. For strategic and revenue improvement reasons, the partnership desired to take a new direction in the management of its business office operations.


Goal

Increase revenue; data and performance visibility and independence compared to using hospital business office. 


Outcome

Increased the medical group’s first year gross collection rate by 34.1%. In year four, the overall increase from initiation is a gross collection rate increase of 38.6%. Revenues increased for the group with steady encounter volume.


Solutions Employed

  1. Replaced and use the firms coding service focused on education in working with physician’s to understand connection between documentation and level of service to optimize revenue opportunity.
  2. Embrace a managed care contracting strategy that maximizes the revenue opportunity for the group considering state laws and nature of services rendered in the community being served.
  3. Isolate the revenue operations process to a team focused on workflow, appeal and denial management and out-of-network strategy team to increase collections.
  4. Deploy patient collection strategies consistent with provision of hospital based services.
  5. Maximize use of technology and interface data sharing between the facility and medical group reducing expenses in overall business operations.