Case Study Revenue Cycle Evaluation

Case Study

Financial Improvement – Revenue Cycle Evaluation

Client

An urban, not-for-profit hospital that merged with another hospital several years ago to create an integrated healthcare delivery system. The organization cares for more than 270,000 patients annually and has over 1,500 employees, making it one of the largest employers in the area.

Challenge

The hospital’s financial leadership had recently changed. The new leadership was uncertain about the current state of revenue cycle operations and wanted to focus on process improvements. The organization’s leadership believed current practices provided an opportunity for revenue enhancement. Revenue cycle controls were not monitored at that time.

Solution

The Nexera team conducted a qualitative and quantitative review of the hospital’s revenue cycle, including comprehensive staff interviews. The team then identified improvement areas that spanned point-of-service collection, financial counseling, denial management, and coding. Working with the hospital staff, Nexera also performed a qualitative no pay analysis to determine the primary reasons for claim denials, then quantified opportunities by payer, inpatient/outpatient, etc.

Results

Quantifiable areas of cash acceleration opportunities included point-of-service collection, select no pay opportunities, and select partial pay opportunities. The Nexera team successfully identified savings that, if implemented, could total as much as $3.4 million.

Nexera, Inc.Case Study Revenue Cycle Evaluation