Credit Balance Reduction
Situation: An integrated health system in the midwest was experiencing high volume of insurance and guarantor credit balances resulting in poor staff and patient experience along with potential compliance risk.
Challenge
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The organization faced a significant challenge with their EMR system generating inaccurate credits due to insurance changes, resulting in a substantial backlog of credits across tens of thousands of encounters, leading to compliance and patient experience issues.
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Despite exploring Robotic Process Automation and system rules, which only tackled a small portion of the credit volume (about 10%), the organization struggled with insufficient staffing to manually address the remaining credits
Solution
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​Emcore staff worked with the client to segment the credit worklists. Approximately 75% of the outstanding credits backlog was assigned to Emcore’s Global Revenue Cycle Capability Center team to be worked.
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After completing 2 weeks of training to understand the organization's policies and procedures, Emcore’s Global Revenue Cycle Capability Center team got to work and resolved the in-scope credits over an 8-week project timeline.
Impact
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Throughout the project duration Emcore’s Global Revenue Cycle Capability Center provided status updates to client’s Patient Financial Services (PFS) leadership, which resulted in less than 5% of the assigned accounts to Emcore to be returned to client.
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With the credit backlog cleaned up, the Organization avoided compliance risks and improved patient experience. In addition, the Finance department was able to accurately reflect Reserves, and showed a positive impact of ~$5M on the financial statements
Accounts Receivable Reduction: Enhancing Cash Flow and Avoiding Revenue Leakage
Situation: An integrated Healthcare system in the midwest is grappling with a shortage of staff, leading to low recovery rates and pockets of aged Accounts Receivable (AR) approaching timely limits.
Challenge
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Staffing shortages, coupled with increased payer denials, were diluting the existing workforce's focus, impacting both critical day-to-day processes and higher-value, newer AR segments.
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Consequently, lower-value AR continued to age, forcing leadership to choose between temporary staffing solutions or outsourcing, each with drawbacks of elevated costs, need for IT and other resources, and loss of control over AR.
Solution
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Emcore's Global Revenue Cycle Capability Center staff emerged as an ideal solution. The process started with an aging and prioritization analysis, laying the foundation for swift recovery impact and improved cash flow.
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After a brief onboarding period, Emcore's Global Revenue Cycle Capability Center staff launched recovery activities for a span of 6 months, operating under the guidance of Patient Financial Services leadership, ensuring productivity, status reporting, and metric enhancements.
Impact
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The organization, leveraging the scalable offshore global model, reduced AR by approximately 3 AR days and experienced a 5% reduction in aged AR.
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This approach empowered the organization to retain operational control and flexibility. The engagement yielded substantial recovery rates, translating to a remarkable Return on Investment (ROI) of 50x.