Funding Their Future Through Revenue Cycle Improvements

The client

Part of a 12-hospital system in the Great Lakes region, this 300-bed hospital needed to get a handle on denials and write-offs.

The challenge

With mounting financial pressure, our client knew they needed to take their revenue cycle performance to the next level.

“Novia’s data-driven approach and ability to connect previously isolated departments improved patient service as well as the hospital’s bottom line,” said Theresa Brandon, Managing Director of Novia Strategies. “As a result of these efforts, our client embarked on a journey to replicate the model at their other hospitals across the health system.”

The approach

By fostering communication and collaboration, we helped our client improve accountability for monitoring reports and prevent continued denials and write-offs. We then turned our focus to developing new processes, metrics and roles that would enable our client to maximize revenue for services performed.

  • Optimizing revenue cycle processes: Creating new processes and monitoring tools, and clarifying roles and responsibilities, improved charge capture, increased collections and reduced recurring errors.
  • Centralizing reviews: Establishing and empowering an interdisciplinary review team, improved documentation, clinical reviews and appeals, resulting in reduced writeoffs.
  • Improving speed and accuracy in the ED: Establishing Emergency Department protocols around patient registration and case management, and extending the hours of case management staff ensured that the right clinical care could be delivered promptly and billed accurately.
  • Expanding patient access: Improving scheduling and registration processes, redesigning processes for the Financial Clearance team, and inviting clinical review nurses to participate in the pre-authorization process allowed more patients to be brought into the system more quickly and efficiently, resulting in increased revenue.

The results

Outcomes

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