“Enhanced Claim Status will present you with extra info extracted immediately from the payer website that you’ll not get in an everyday declare standing.”
—Jake Reid, Senior Director of Income Cycle Enterprise Places of work at St. Luke’s Health System
Problem
St. Luke’s Health System is Idaho’s largest healthcare supplier, dealing with over three million outpatient visits per yr and processing greater than 450,000 claims per thirty days. Because the group grew, rising affected person volumes put strain on employees to maintain billing processes operating easily. They wanted a scalable resolution to handle claims observe-ups with out rising headcount or compromising affected person care.
“We had a rising inhabitants and a rise in accounts receivable (AR),” says Jake Reid, Senior Director of Income Cycle Enterprise Places of work at St. Luke’s. “We couldn’t sustain. To proceed to meet our mission to assist our communities and keep financially sound, we wanted a extra environment friendly method to accumulate income.”
They targeted on 4 key questions:
- How can we maximize employees effectivity by bettering submit-declare observe-up?
- How can we leverage expertise to deal with rising account volumes with out rising headcount?
- How can we keep away from wasted touches so employees can concentrate on accounts that require observe-up?
- How can we speed up AR restoration to enhance money move and cut back getting older?
Resolution
After exploring in-home and outsourced choices, St. Luke’s determined to implement Experian Health’s Enhanced Claim Status to automate and streamline the claims observe-up course of. The device pulls adjudication knowledge immediately from payer websites and delivers detailed declare statuses inside Epic, eliminating the necessity for workers to manually monitor claims by payer portals or await remittances.
What began as a pilot with only one payer rapidly expanded to incorporate different excessive-impression payers. The workforce favored how Enhanced Claim Status supplied actual-time insights into denied, rejected and pending claims, so that they had been in a position to prioritize and resolve points sooner. Claims are routinely routed into work queues primarily based on custom-made guidelines, accelerating observe-up by one to 2 weeks. This allowed employees to concentrate on the precise accounts and diminished pointless work.
Reid says, “Enhanced Claim Status will present you with extra info extracted immediately from the payer website that you’ll not get in an everyday declare standing.” The workforce values this richer knowledge, which incorporates enhanced knowledge like proprietary motive codes and actionable explanations for every declare. St. Luke’s labored intently with Experian Health to make sure all mandatory fields had been captured from payer responses and arrange for payers not already supported, so no claims had been neglected. They had been in a position to set their very own guidelines for standing checks, retry intervals and cutoff factors, and declare standing codes had been categorized to find out probably the most acceptable work queue, primarily based on St. Luke’s personal necessities. All payer responses are routinely formatted in a constant approach, so employees can proceed to work effectively, regardless of what number of new payers are added.
Learn the weblog: 6 steps to bettering the claims adjudication course of
End result
Shifting to automated declare standing checks considerably diminished the executive burden, attaining the next monetary outcomes:
- Denials dropped by 76%, falling from 27% to simply 6.5% since 2017
- “Discharged/not billed” accounts had been diminished by $15 million per thirty days
- Hospital billing aged over 90 days now constantly meets Epic’s Silver or Gold benchmarks, with the watch record down from a mean of $13 million to beneath $1 million since going reside in 2019
- Affected person billing over 90 days now sits at simply 4.5%, placing St. Luke’s among the many prime performers of Epic customers
Automation additionally helped St. Luke’s save the equal of three full-time employees every year. With fewer unbilled accounts and extra environment friendly workflows, the general price to gather went down. Workers appreciated having higher knowledge and extra time to concentrate on complicated accounts, which elevated their capability to assist sufferers immediately.
Reid says that with Enhanced Claim Status, the group has efficiently achieved its objective of accelerating AR decision and denials administration, with out overburdening employees. He attributes this to steady testing, enchancment and shut collaboration with Experian Health:
“A lot of our success got here from customizing the construct to our workflows and processes. You’ll lose momentum and employees purchase-in for those who don’t make sure the construct is stable. The significance of testing can’t be underestimated. Lastly, guarantee you’re checking in with Experian usually to deal with any points that come up. Experian has all the time been very aware of my groups and I’d anticipate that to be the identical for you.”
Discover out extra about how Enhanced Claim Status accelerates declare observe-up and improves money move.
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