Many organizations are grappling with financial hurdles, and one of Georgia’s largest health systems was no exception.
Facing increased labor costs, a growing backlog in accounts receivable, and persistent issues with denied claims, the system found itself in need of expert intervention.
This is where we came into play, bringing a solution that not only resolved these challenges but delivered an impressive 10X return on investment.
Identifying the Problem
The health system’s difficulties began with escalating labor costs, which were compounded by a backlog of receivables.
Low-dollar lab claims became particularly challenging to manage, stretching resources thin and causing delays in their resolution. The organization was also in the midst of transitioning from GE Centricity to Epic Hyperspace, a move that introduced complexities in managing legacy accounts while maintaining cash flow. Aged receivables began to pile up, creating a critical situation where the organization risked missing filing deadlines and losing valuable revenue.
Another issue was visibility into key performance metrics. Without clear insights into denial trends, the organization struggled to optimize its revenue cycle. This lack of transparency left them without the necessary tools to identify the root causes of their problems and implement timely solutions.
Additionally, a surge in denied claims, particularly Medicare Return to Provider (RTP) claims, further hindered their ability to achieve financial stability.
Implementing a Solution
After nailing down the issues, we worked with their team to develop and implement a comprehensive strategy to address these pressing challenges.
Within just four weeks, we ramped up staff to manage the growing volume of claims, processing over 100,000 additional claims—far beyond the original scope of work. Our intervention brought immediate relief to the backlog and positioned the system for a more efficient revenue cycle.
The results were significant. In the first six months of SYNERGEN’s involvement, aged receivables beyond 120 days were reduced by 80%.
This was achieved through a combination of proactive measures aimed at tackling denial causes head-on, optimizing system rules, and improving the workflow for claim follow-ups. Medicare RTP claims, which had previously caused significant delays, saw a turnaround time reduction to just 48 hours.
In addition to operational improvements, we introduced advanced reporting and analytics, giving the organization unprecedented visibility into its denial trends and key performance indicators. Armed with this data, they could make informed decisions, which directly contributed to optimizing their collection efforts and overall financial performance.
Another crucial part of our strategy was their success with claim resubmissions and appeals. Our efforts resulted in a 49% success rate in resubmitting previously denied claims and a 33% success rate in winning medical record appeals. These victories translated into an additional $11.1 million in collected revenue, far surpassing the initial projections and providing the organization with an ROI that was 10X higher than expected.
Find Long-Term RCM Success
Increased visibility, operational improvements, and the expertise to navigate a complex transition all lead to this health system recovering millions in revenue, proving that the right partner can make all the difference in healthcare management.
If your organization is facing similar challenges, SYNERGEN Health is ready to provide the expertise you need to achieve your financial goals.
