Strategic Escalation in the Face of Rising MA Plan Denials Originally published on Becker's Hosptal ReviewRelationships between providers and Medicare Advantage (MA) plans have become more strained as payers aggressively deny claims. To ensure providers' financial...
CASE STUDY
Revolutionizing Revenue Recovery
How CorroHealth helped a Non-Profit Hospital Recoup $116 Million in Aged Accounts
The Situation:
A non-profit hospital faced a tough decision when their Accounts Receivable (AR) vendor failed to perform, leaving a backlog of small balance accounts aged between 180 to 210 days. The hospital was confronted with a choice between writing off the revenue or recouping it. Fortunately, they turned to CorroHealth, a trusted partner in the healthcare industry, to help them solve the problem and maximize returns.
The Challenge:
Small balance accounts, which account for 1 to 5 percent of revenue, often take up 55-60 percent of work for the Accounts Receivable department. These accounts are usually worked without fixing the root causes, and there is often a shortage of staff to handle the workload. As a result, hospitals may abandon revenue that is difficult to collect or write it off as bad debt. The hospital faced a similar challenge, but CorroHealth had the technology, analytics, and expertise to identify the root causes of the delays, repair them, recoup aged revenue, and help the hospital achieve sustained success.
The Action:
CorroHealth had a proven track record of helping hospitals compliantly recover revenue from payers of all sizes, from critical access facilities to large hospital systems. Typically, around 20 percent of commercial claims remain uncollected after 180 days. CorroHealth took on the small balance claims that had already been worked by the previous vendor, becoming the hospital’s pre-write-off service partner. Instead of replacing the hospital’s billing staff, CorroHealth acted as an extension of the team, working alongside them to provide support and guidance.
One key benefit of this partnership was that it allowed the hospital’s billing staff to fully focus their energy on the remaining 80 percent of AR. CorroHealth quickly identified weaknesses and vulnerabilities in the revenue cycle and provided data-based recommendations to help the hospital train its staff to process aging accounts more successfully. The process began with CorroHealth gathering the hospital’s small balance data and funneling it through its proprietary technologies and methodologies. Using this data, CorroHealth specialists performed a root-cause analysis and pinpointed areas where the hospital fell short across the revenue cycle. They identified errors in front-end patient demographics, ICD coding errors, missing supporting documentation required by payers, and billing system software glitches that misrouted data – all of which were avoidable and resulted in payer denials. Armed with actionable information, the hospital had the guidance it needed to train its staff to avoid similar errors, resulting in fewer small balance accounts.
The Results:
By working with CorroHealth for over 10 years, the hospital successfully recouped revenue from small balance accounts that would have otherwise been written off. The partnership resulted in a decrease in AR aged days and an improvement in the bad debt ledger. The numbers speak for themselves: 100 percent resolution of all assigned claims, 67 percent average net collection rate on accounts that would have otherwise been written off, a decrease in aged small balance amount from $171 million to $91 million (a 47% decrease), and a decrease in the average account balance by 45%.
This process was so effective that CorroHealth re-submitted the aged claims and recovered an average of $11.6 million per year, every year, for 10 years – $116 million total – strengthening the hospital’s financial balance and enabling them to provide the highest quality care to the community they serve.
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