Safety Net Hospital Captures Cash
The Challenge
Located in an underserved community in the New York metropolitan area, Bronx Lebanon Hospital Center employs over 600 physicians seeing patients both in its faculty practice plan and its hospital based ambulatory practices.
The Hospital’s physician organization had uneven revenue cycle performance over the past several years, leading to financial pressures and physician dissatisfaction. The Hospital executives wanted an assessment of its current operations with an action plan to stabilize and improve its revenue stream.
The Story
Bronx Lebanon Hospital Center engaged Goldman Health Strategies to assess all stages of its physician revenue cycle ranging from registration and insurance verification through coding and charge capture to follow up and collections. The goal was to identify opportunities for improvement and determine annual financial benefits.
The Solution
Partnership
Leading the Hospital team, the newly appointed Vice President of Managed Care and Faculty Practice partnered with Goldman Health Strategies to identify how to bring its physician revenue cycle to the next level. Goldman Health Strategies made a series of recommendations to improve practice plan governance, charge capture and billing that were embraced and implemented by BLHC management.
Process Review and Analysis
After review of historical financial data, discussions with staff, first hand observations at the practice sites and with the billing vendor, Goldman Health Strategies quickly determined that many of Bronx Lebanon’s challenges were the result of lack of accountability at Bronx Lebanon and flawed revenue cycle processes. For example, insurance verification, charge capture and code assignment were either incomplete or inaccurate, leading to delays in billing, insurance denials and uncaptured revenue.
Quantification and Recommendations
As a result, Goldman Health Strategies issued a series of recommendations in seven key areas:
Charge Capture and Reconciliation
Coding
Credentialing
Insurance Verification and Pre-Billing Revenue Management
Denial Management
Information Technology Enhancements
Together, these recommendations had the potential of increasing revenue from 15-36% without any increase in volume. Goldman Health Strategies provided an action plan to implement these recommendations, resulting in an increase of a 20% increase in revenue after one year for the same group of physicians.
The Results
One year later, Bronx Lebanon Physician Services had a 20% increase in physician revenue. Bronx Lebanon stabilized operations, changed vendors, reduced billing costs, and improved revenue performance.