Case Study – Full Business Office Outsourcing Services

ARx CLIENT

The ARx client featured in this case study is a not-for-profit, integrated healthcare system in the eastern United States that serves more than 3.5 million people in 34 counties spanning three states. The system has over 26 facilities that include large acute care hospitals, small rural hospitals and a number of outpatient centers and specialty clinics.

SITUATION/ CHALLENGE

In 2006 the healthcare system purchased a 60-bed Community Hospital from another large hospital system. At the time of acquisition, the hospital was operating without a business office due to the previous owner’s “shared services” strategy which included a centralized business office environment. Since the acquiring hospital system utilized a similar approach, the eventual plan was to roll the Community Hospital’s A/R into the new company’s central business office. It would not be possible for the transition to immediately occur however, as the hospital needed to be converted to the new company’s operating environment. In the meantime, hospital revenue was expected to continue under the older A/R system until March of 2007. In addition, issues such as Provider number-related delays with governmental payers were starting to become a concern. As a result, the acquiring hospital system realized that an interim business office solution was needed.

ARx SOLUTION

Due to the selling hospital system’s positive experiences with ARx during previous ownership transition events, and throughout the extended roll out and migration period of their internal shared services strategy (which created internal demand for interim business office solutions), ARx was referred to the acquiring company as an experienced resource to handle the full business office requirements of the Community Hospital until the system conversion was complete.

ARx Full Business Office Services included:

  • Set up and maintained master files
  • Worked all Business Office unbilled alerts and coordinated Medical Records and Admitting alerts
  • Provided billing service for all new and re-billed claims
  • Provided all insurance collection services
  • Set up lockbox for payment processing
  • Provided all cash posting and G/L balancing
  • Performed credit balance reviews and processed insurance/ patient credit balance requests
  • Worked managed care denials and discrepancies
  • Logged and tracked all Medicare Bad Debt
  • Submitted quarterly Medicare Credit Balance Reporting
  • Worked and maintained all correspondence
  • Worked all self pay accounts (Letters and phone calls)
  • Submitted self pay accounts to primary agency after early out cycle was completed
  • Provided monthly A/R reports and ad hoc report requests
  • Held weekly conference calls throughout project

Outcomes included:

  • Bills were submitted within 5 days of the conversion
  • Achieved high resolution percentages of outstanding gross A/R monthly
  • Reduced A/R of $22 million by more than 96% (remaining 4% is patient payment arrangements)
  • Resolved all outstanding credit balances

TODAY

The healthcare system successfully completed the Community Hospital’s system conversion in the Spring of 2008 and is now utilizing ARx’s Data Warehousing services on an ongoing basis.