Background and Challenges
In 2017, Bon Secours Health System, a not-for-profit Catholic health system, sought a Revenue Cycle Management (RCM) solution for its acute care hospitals to effectively address challenged related to denials.
The overall goal of the RCM initiative was to ensure clinical and operational excellence while supporting the financial viability of the organization. The health system had undergone significant expansion over the past few years, including the full deployment of a brand new EHR system, yet dealing with massive sets of disparate data to be reconciled and reviewed, and adding a significant degree of complexity to RCM processes throughout the enterprise.
The leadership of Revenue Cycle Services and Revenue Integrity department of Bon Secours began to identify potential solutions, including EFFY powered by RAID Healthcare.
The revenue cycle leadership team evaluated several vendor solutions. Since they had already invested significant funds in an overall operating system (EPIC) and some analytic tools, they had no intention of discarding the operating system and replacing it with a different and equally expensive transaction-based model.
When the leadership team saw the EFFY demo of RAID Healthcare, including the reconciliation and analytical tools that could gather and compare data enterprise-wide, detect deviations, issue alerts and offer an integrated workflow to guide the 'fix,' they were convinced.
Preventing denials before they occur in first place, rather than using regular denials management tools that only act after fact, was a big breakthrough that made EFFY´s solution stand out from the alternatives in the market.
Results and ROI
After first year of utilization of EFFY and its powerful RAID Healthcare analytic tools, Bon Secours team was impressed by the amazing outcomes and ROI of the solution.
Savings related to denials have exceeded a few millions only in this specific clinical area and write-offs continue to accrue every day, making solution pay itself in less than 6 months, triggering a roadmap of deployment of the tool into other business areas where revenue leakages exist.
On top of the immediate and objective financial savings that result from the substantial reduction of denial write-off rates, back-end processes are now streamlined, relieving stress and time constraints imposed on the clinical staff.
Inadequate or missing documentation of medical necessity has been addressed, allowing hospitals to transition charges to patient self-pay or to initiate a change in the course of treatment.
Not only has there been an elimination of denials there has also been a decrease in AR days as a result of producing a clean claim with the first bill.