Case StudySparrow Health System

Sparrow Health System strengthens �nancial position with Convergent’s �exible, low maintenance, legal-backed approach to revenue cycle management.

Sparrow is the largest health system in mid-Michigan, with two campuses in Lansing, Sparrow Clinton Memorial Hospital in St. Johns, and Sparrow Ionia Hospital in Ionia.

Issues

Like many other hospitals across the country, Sparrow Health System struggled with a large volume of aging claims. With back office staff already busy working current receivables, the cash potential of these older accounts remained untapped.

Eager to generate revenue from inappropri-ately denied claims and delayed payments from non-government payers, Sparrow turned to Convergent Revenue Cycle Management, Inc. for help. Convergent has two decades of demonstrated success helping healthcare organizations tackle complex reimbursement challenges such as older receivables. With its low maintenance approach to outsourcing and a robust staff of legal experts to accelerate collections, Convergent was a sound choice for Sparrow.

Answers

Convergent began at once working on Sparrow’s backlog of claims, tackling the high volume of mid-value claims aged 180 days and older. With experienced collectors working on and off site, Convergent made the transition to outsourcing immediate for Sparrow. “Vendors always promise an easy transition, but it doesn’t usually work out that way. I was truly impressed with how seamless the Convergent transition process was. They worked with the information we gave them to

deliver on their promise of low maintenance outsourcing,” said Kevin Sharp, Director of Revenue Cycle for Sparrow.

Convergent’s unique attorney-led approach to collections brings legal expertise to problem claims, helping to quickly resolve issues and expedite payment.

The direct supervisor of the Convergent collectors who work Sparrow accounts is an attorney, able to put appropriate pressure on payers for denied and delayed payments. Convergent’s legal department handles the higher value accounts from Sparrow, where their clout and expertise help to ensure prompt payment.

Sparrow’s billers also benefit from the knowl-edge and insight of Convergent’s legal team. “Convergent regularly gives workshops for our staff to help them understand laws and regulations, such as ERISA and state-specific clean claims laws. With this knowledge, they now know when to pursue claims, what to ask, and how to ask. Our billers become much more effective and more confident in working problem accounts,” said Amy Kremkow, Manager of Facility Billing.

The relationship between the two organizations is more akin to a partnership than that of a vendor and client, with Convergent looking beyond its own business goals to help Sparrow improve its revenue cycle processes and reduce the incidence of problem accounts.

“Our experience with Convergent has brought

revenue to our bottom line, improved our cash

flow and reduced denials. They have delivered on

every promise made during the sales process

and set out in the contract.”

Kevin SharpDirector of Revenue Cycle

Sparrow Health System

888.511.7901 www.convergentusa.com/healthcare Page 1

“Convergent is always thinking of new processes to help us improve our own collec-tion efforts,” Kremkow pointed out.

For example, Convergent was able to:

• Identify “no authorization” as the most common denial among aged claims and worked with the hospital to improve the patient access process for obtaining authorizations.

• Uncover a carrier regularly taking large discounts not in line with the contract between the two organizations and worked to adjudicate these claims.

• Establish a relationship with the U.S. Department of Veterans Affairs, securing a contact for following up on delayed claims and settling them more quickly.

As Sparrow’s needs change and new issues arise, Convergent has the flexibility to adapt and respond to the unexpected, continually evolving processes and on-site staffing—or even going further. “In the face of a mini budget crisis, Convergent renegotiated fees and services to help us meet our targets,” said Sharp. “They really helped us out, demonstrat-ing their commitment to our business needs.”

Outcomes

Sparrow brought Convergent on board to collect accounts that would otherwise be written off as bad debt. Convergent has excelled at converting these problem accounts to cash. “Our experience with Convergent has brought revenue to our bottom line, improved our cash flow and reduced denials. They have delivered on every promise made during the sales process and set out in the contract,” said Sharp.

With Convergent focusing on aged accounts, Sparrow billers can fully focus their efforts on more collectible current accounts. “With Convergent, our billers are able to stay focused on current accounts before they age, helping us to significantly reduce our accounts receivable days,” said Susan Allen, Financial Clearance Supervisor.

The relationship with Convergent has also introduced new processes for collecting accounts in a more timely way, helping to reduce total receivables. Collecting on accounts before they age has in turn helped the healthcare system to reduce the fees it pays to Convergent.

“Convergent constantly gives us feedback, reports, and education sessions to help us improve our processes. They don’t just work the book of business we give them, but help us improve our overall business, even if it means less business for them. They are a real part of our team,” said Sharp. “Since they have been so willing to help us improve our overall business in this denied and problem claim area, we will continue to consider them as potential partners in other areas of need.”

Derek Pickell, President for Convergent Revenue Cycle Management, explained how its revenue outsourcing services have helped Sparrow, “Our low maintenance approach to outsourcing, the legal expertise we bring to problem accounts and our flexibility in responding to changing needs have helped Sparrow to strengthen its financial position and continually improve the services it provides to its patients. We always strive to be a true partner and an extension of our customer’s management staff.”

About Convergent

Formed in 1992, Convergent combines healthcare-focused legal expertise, advanced technology and superior claims reimbursement management to deliver outstanding results for more than 630 hospital clients, resolving their most significant receivables management challenges.

With more than 690 employees, including more than 60 healthcare attorneys, Convergent is the leading provider of solutions for non-governmental insurance, self-pay, Workers' Compensation, motor vehicle accident and aged problem claims, as well as patient access solutions. In addition to helping our clients resolve their most complex reimburse-ment issues, Convergent’s legal workshops, training and real-time interactive reporting enhance all aspects of the revenue cycle. Learn about our services at www.convergentusa.com/healthcare.

“Our low maintenance approach to outsourcing,

the legal expertise we bring to problem accounts

and our flexibility in responding to changing

needs have helped Sparrow to strengthen its

financial position and continually improve the

services it provides to its patients.

We always strive to be a true partner and an

extension of our customer’s management

staff.”

Derek PickellPresident

Convergent Revenue Cycle Management, Inc.

Copyright © 2012 ConvergentAll rights reserved.

Convergent Revenue Cycle Management, Inc.

13575 Heathcote BoulevardSuite 300Gainesville, VA 20155888.511.7901

www.convergentusa.com/healthcare

888.511.7901 www.convergentusa.com/healthcare Page 2