Case StudyThird-Party Reimbursement

Issues

Answers

Director of Revenue Cycle The Health System

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

Like many other hospitals across the country, this health system struggled with a large volume of aging claims. With back office staff already busy working current receivables for its four locations in central Michigan, the cash potential of these older accounts remained untapped.

Eager to generate revenue from inappropriately denied claims and delayed payments from non-government payers, the health system turned to Convergent Revenue Cycle Management 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 the health system.

Convergent began at once working on the health system’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 simple and immedi-ate. “Vendors always promise an easy transi-tion, 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 the health system’s director of revenue cycle.

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

An attorney supervises the Convergent collectors who work accounts and is able to put appropriate pressure on payers for denied and delayed payments. Convergent’s legal department handles the higher value accounts from the health system, where their expertise and clout help to ensure prompt payment.

The health system’s own billers benefit from the knowledge and insight of Convergent’s legal team. “Convergent regularly gives workshops for our staff to help them under-stand 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 the health system’s manager of facility billing.

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

“In the face of a mini budget crisis, Convergent

renegotiated fees and services to help us meet our targets,” said the director of revenue cycle. “They really

helped us out, demonstrating their commitment to our

business needs.”

888.511.7901 www.convergentusa.com/healthcare Page 1

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.

Outcomes

Derek Pickell CEO

Convergent Revenue Cycle Management, Inc.

Copyright © 2014 ConvergentAll rights reserved.

Convergent Revenue Cycle Management, Inc.

13575 Heathcote BoulevardSuite 300Gainesville, VA 20155888.511.7901

www.convergentusa.com/healthcare

As the health system’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 the director of revenue cycle. “They really helped us out, demonstrating their commitment to our business needs.”

The health system brought Convergent on board to collect accounts that would otherwise be written off as bad debt, and 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 the director of revenue cycle.

With Convergent focusing on aged accounts, the health system’s billers can fully focus their efforts on current accounts before they age, helping to significantly reduce accounts receivable days.

“Convergent is always thinking of new processes to help us improve our own collection efforts,” said the manager of facility billing.

For example, Convergent was able to:

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 the director of revenue cycle.

Derek Pickell, CEO for Convergent Revenue Cycle Management, explained how its revenue outsourcing services have helped, “Our low maintenance approach to outsourcing, the legal expertise we bring to problem accounts and our flexibility in responding to changing needs have helped the health system 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.”

“Our low maintenance approach to outsourcing,

the legal expertise we bring to problem accounts

and our flexibility in responding to changing needs have helped the

health system to strength-en 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 custom-er’s management staff.”

888.511.7901 www.convergentusa.com/healthcare Page 2

About Convergent Revenue Cycle Management, Inc. (CRCM)Formed in 1992, CRCM combines healthcare-fo-cused 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 nearly 600 employees, including more than 50 healthcare attorneys, CRCM has been the leading provider of solutions for patient contact center solutions including financial clearance, early out / self pay follow-up and bad debt collections as well as non-governmental insurance, self-pay, Workers' Compensation, motor vehicle accident, and aged problem claims for over 20 years. In addition to helping our clients resolve their most complex reimbursement issues, CRCM’s legal workshops, training and real-time interactive reporting enhance all aspects of the revenue cycle.

Learn more about our patient contact center and reimbursement services at www.convergentusa.com/healthcare.