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The road to CASH 
isn’t paved with 
good intentions…
The road to CASH is paved with ACTION! 
At re|solution, we’ve built our reputation on more than a decade of improving revenue cycle operations for healthcare 
providers throughout the country. We provide revenue cycle process and technology solutions that result in both immediate 
and sustainable improvements to a provider’s cash flow, profitability and revenue cycle efficiency. In addition to finding the cash 
that falls through the cracks in revenue cycle and billing processes, our on-site approach establishes a knowledgeable and 
confident business office staff that operates with greater efficiency, higher productivity and better financial results. 
Just as healthcare itself must meet the specific needs of each patient, re|solution offers a full spectrum of revenue cycle 
services – customized to meet the unique needs and constraints of each of our clients in the communities they serve. 
re|solution’s technology solutions and its renowned educational, mentoring approach can improve every aspect of your revenue 
cycle. We are proud to say that we have provided an overall net CASH gain to every one of our clients. 
• Poor cash flow? 
• Days of cash on hand < 20 days? 
• High AR over 90 days? 
• Recent loss of key personnel? 
• Lack of qualified and/or 
experienced personnel? 
• Cost to collect higher than 3%? 
• Recent system conversion? 
• APC Index < 3.0? 
symptoms
• Revenue Cycle Assessment 
• Cash Acceleration 
• Interim Staffing 
• Virtual Business Office 
Outsourcing 
• Reimbursement Review 
• Self Pay Management 
• Charge Capture Review 
tre a tm e nts 
su s ta i na b l e cu re 
• Cash is up 
• Receivable days down 
• Increased reimbursement 
• Education and mentoring 
of staff on-site 
• Improved processes and 
procedures 
• Roadmap for long-term 
success 
• Peace of mind 
Call re|solution today at 1.800.355.0410 
For a FREE Benchmark Indicator Analysis, 
visit us at www.ereso.com
re|solution provides highly effective, tailored solutions to the business 
challenges faced by hospitals, outpatient facilities, physician practices, 
clinics, DME and home health providers. 
363 centennial pkwy – suite 105, louisville CO 80027 • phone 303.530.0396 • toll free 800.355.0410 • www.ereso.com
Map of Engagements 
At re|solution, we’ve built our reputation on more than a decade of improving revenue cycle 
operations for healthcare providers throughout the country. We provide revenue cycle process and 
technology solutions that result in both immediate and sustainable improvements to a provider’s cash 
flow, profitability and revenue cycle efficiency. In addition to finding the cash that falls through the 
cracks, our on-site approach establishes a knowledgeable and confident staff that operates with greater 
efficiency, higher productivity and better financial results. Visit us at www.ereso.com.
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Other benefits include: 
 Reduced days in A/R 
 Improved bottom line 
 On-site training 
 Proprietary reporting tools 
 Improved management information 
 Sustainable results 
 Peace of mind 
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“The re|solution team was so helpful and 
had so many good ideas that they quick-ly 
gained the trust of the full-time staff. 
Everyone was happy to have them on 
board and soon realized the value of 
their expertise.” 
John Wilker, Chief Financial Officer 
Portneuf Medical Center 
Carson Tahoe Regional Medical Center (“CTRMC”) is a 140 bed facility just south of Reno, Nevada. 
With over 30,000 patient visits per year, CTRMC had a negative adjustment to their net Accounts 
Receivable of nearly $6,000,000 when their management embarked on a process to find any and all 
opportunities for cash and bottom line improvement. 
re|solution was engaged and assigned all insurance accounts over 90 days. During the first quar-ter 
of the engagement, cash collections were 40% higher than cash collections for the same quarter 
in the prior year. 
In addition, re|solution provided added services for CTRMC’s business office staff, such as training 
in billing and follow-up techniques and a detailed revenue cycle assessment at no additional cost. 
The hospital administration was ecstatic about the increased cash flow. The improvements identi-fied 
and implemented by re|solution were continued after the engagement ended. 
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 Experienced and knowledgeable analysts work your aged accounts 
 On-site training and mentoring of your staff insures long-term improvements 
 Inefficiencies identified and recommendations made for customized process improvements 
 Safety net of re|solution resources provide post engagement support 
 Post engagement quarterly benchmark reports verify your success 
For additional information: 
info@ereso.com 
toll free 800-355-0410 
www.ereso.com
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Other benefits include: 
 Cash increases with improved staff skills 
 On-site knowledge transfer produces competent 
local employees 
 On-site training/mentoring increases skill retention 
 Temporary or long-term placements 
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“Your placement of an interim busi-ness 
office manager helped us begin 
the process of implementing the rec-ommendations 
Lavaca Medical Center (“LCMC”) is a 25-bed community hospital in south central Texas providing a 
wide range of inpatient and outpatient services. LCMC’s business office manager resigned. Months 
of searching for a replacement resulted in no qualified candidates, so LCMC identified an individual 
from another department to become the new business office manager. 
re|solution was engaged to mentor/train the individual selected. During the first three months of the 
engagement, the on-site re|solution interim business office manager managed the business office 
while the new business office manager shadowed and learned effective business office manage-ment. 
During the second three months, the new business office manager managed the business 
office and the on-site re|solution interim business office manager provided support while writing 
policies and creating a reporting structure. 
During the six month engagement, LCMC also underwent a difficult system conversion. Cash 
remained relatively steady even with the turnover and system conversion problems. The new busi-ness 
office manager received continued support from the re|solution interim business office 
manager who remained a resource after the training/mentoring engagement ended. 
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 You select from our elite reserve of qualified personnel 
 Mentoring option for training managers or higher level personnel 
 Implementation of unique reporting and productivity tools with monthly reports to measure 
employee performance 
 Safety net of re|solution resources provide post engagement support 
made in your assess-ment. 
Your continued support in the 
months following the engagement, 
including assistance in interviewing 
candidates for the permanent busi-ness 
office manager, enabled us to 
put the blocks in place during this 
transitional period as we worked to-ward 
long-term stability.” 
Bob Ellzey, President/CEO 
Laird Memorial Hospital 
For additional information: 
info@ereso.com 
toll free 800-355-0410 
www.ereso.com
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Your new system conversion date is nearly here. You and your leadership team and staff have dedicated a 
large amount of time to implementation, planning and training while at the same time trying to maintain current 
operations. System implementations are complex and at times can be overwhelming, and despite your best 
efforts, key performance indicators can begin to move in the wrong direction. 
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You and your staff are working hard, but… 
 Cash collections are decreasing 
 A/R days are increasing 
 Your staff is having difficulty completing their current work while building and training on the new system 
 Key managers are required to dedicate time preparing for the implementation 
 There is pressure to retire your old legacy system early to reduce costs 
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re|solution’s System Conversion A/R Wind Down (re|wind) solution combines our highly trained staff, with 
proven experience in A/R liquidation and cash acceleration during system conversions, with the efforts of your 
staff. 
Our re|wind solution creates a synergy that: 
 Provides a cost effective alternative to working your post conversion A/R internally 
 Ensures that your pre and post conversion cash collections remain at or exceed current performance 
 Allows your revenue cycle leadership and key personnel to focus on successful implementation and training 
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Maintaining pre-conversion performance in cash collections, A/R, and bad debt expense is the key to an effec-tive 
and ultimately successful system conversion. Our re|wind solution will deliver the following results: 
 Significantly increases the likelihood of a successful system conversion 
 Consistent cash collections before, during, and immediately after the conversion 
 Assists with maintaining other key revenue cycle performance indicators at current levels 
 Potential reduction of system maintenance costs by early retirement of old legacy system 
For additional information: 
info@ereso.com 
toll free 800-355-0410 
www.ereso.com
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Other benefits include: 
 Training provided by highly skilled revenue cycle management experts 
 On-site, one-on-one training insures retention 
 Create well-trained staff without recruiting new personnel 
 Application of proprietary software to monitor employee progress and performance 
 Sustainable business office process improvement 
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re|train is a cost-effective way to provide new or less experienced business office staff and manage-ment 
with receivables management skills. The service is conveyed one-on-one by a re|solution 
revenue cycle operations expert. Throughout the training, your staff completes a series of written 
and oral exercises to verify comprehension and retention of the material. re|solution also applies 
proprietary software to monitor employee performance. 
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 Review and compare your facility’s key revenue cycle indicators to those of best practice 
organizations, with instructions on how to use benchmarking to monitor, manage and improve 
business office performance 
 A re|solution revenue cycle operations expert will provide in-depth instruction on: 
 Bad debt and contractual reserves 
 A/R management influences on the income statement and balance sheet 
 Determining if changes in A/R are due to revenue fluctuations or process breakdowns 
 Understanding the causes of key indicator variances and options for corrective actions 
 Utilizing the Aged Trial Balance and other reports as management tools 
 Create a responsibility matrix that optimizes the skills of individual staff members in assignment 
of key business office functions and processes 
 Develop performance expectations and productivity standards including prioritizing tasks and 
developing effective time management strategies. Apply proprietary re|solution management 
tools and motivational techniques to improve revenue cycle performance 
 Daily performance tracking, monthly site visits or calls to review progress and answer questions. 
 Verbal exit conference and written report for hospital senior management at the conclusion of 
the engagement 
For additional information: 
info@ereso.com 
toll free800-355-0410 
www.ereso.com
re|store 
Insourced Business Office 
Guaranteed Performance Improvement 
Other benefits include: 
 Transparent pricing—no surprises 
 Guaranteed bottom line increase 
 No more staffing issues 
 Improved dashboard reporting 
 Implementation of new technology 
 Peace of mind 
Real Life Results 
“We had been without a 
business office manager and our 
issues were severe. The 
transition was relatively easy, and 
the results practically immediate. 
re|solution took over only the 
necessary positions, trained 
those we desired to have stay, 
and the billing office began to 
function efficiently. I can’t say 
enough good things about our 
experience with re|solution” 
Mike Click, CEO 
Brownfield Regional Medical Center 
When Brownfield Regional Medical Center (“BRMC”) in NW Texas engaged re|solution, BRMC’s 
AR days were at 131, compared to a peer average of 48 days, days of unbilled AR was at 27 
compared to the peer average of only 10, and total AR was at $4.5 million. re|solution was selected 
to “insource” the business office by hiring all BRMC employees and placing a seasoned business 
office manager to lead the revenue cycle. 
re|solution assumed responsibility for BRMC’s 21 revenue cycle employees. During the re|store 
engagement, re|solution reduced the outstanding AR to less than $2 million and decreased the total 
business office staff needed to run the operation by implementing process improvement and 
increasing operating efficiencies. After several years, re|solution assisted BRMC in returning to an 
in-house Business Office once operations were stabilized and BRMC desired to bring the work back 
in-house. 
Methodology 
 All costs of the revenue cycle assumed by re|solution including cost of other revenue cycle 
vendors 
 Pricing set at current costs plus 10% 
 Guarantee that additional reimbursement will exceed 100% of additional costs or contract may 
be terminated 
 Manage and train current staff 
 Optimize current patient accounting system 
 New technology introduced to improve reimbursement 
 Monthly accountability, productivity and benchmarking reports 
For additional information: 
info@ereso.com 
toll free 800-355-0410 
www.ereso.com
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Using a comprehensive initial assessment of the revenue cycle, re|solution identifies areas where 
the facility has not received the reimbursement for which it is entitled. The assessment looks at all 
phases of the revenue cycle including: scheduling, registration, charge capture, coding, billing, 
collections and reimbursement. The assessment will identify claims to be rebilled, changes in pro-cess 
that will generate additional dollars and other opportunities to move towards a best practices 
revenue cycle. re|solution guarantees that the cost of the assessment will be covered by opportu-nities 
found for additional reimbursement. 
Once the initial assessment is completed, re|solution works with two departments each quarter to 
assist them in improving charge capture, documentation and coding practices to insure that the 
facility is being paid the correct amount for all services that are performed. In addition, for a year 
following the assessment, re|solution will monitor the implementation of each recommendation to 
insure effective implementation. Once again, re|solution guarantees that the cost of this quarterly 
implementation and monitoring is covered by additional reimbursement. 
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The challenges faced by rural and community hospitals are enormous. The same charge capture, 
coding and reimbursement issues that plague larger facilities also affect rural and community 
hospitals with less resources to insure compliance and appropriate reimbursement for services 
provided. re|solution’s re|grip program provides a safety net to insure that the provider receives all 
the monies they are due. 
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Using proprietary technology, interviews and a proven continuous improvement and monitoring pro-cess, 
this no-risk program allows personnel at the departmental level to work with the revenue cycle 
personnel in optimizing reimbursement. This is the key to an effective revenue cycle when you can 
get the clinicians and the business people working together. The process also allows the facility to 
explore other opportunities for improvement such as point of service collections, denial manage-ment, 
self pay management, contract payment review and EHR implementation for meaningful use. 
This safety net gives our clients the peace of mind that all services are being reimbursed at an ap-propriate 
level. 
For additional information: 
info@ereso.com 
toll free 800-355-0410 
www.ereso.com
Benchmark Indicator Analysis 
How does your facility compare nationally with other facilities of your respective size? 
re|solution is a hospital expert, providing superior accounts receivable management, revenue cycle analysis, 
training, APC and CDM reviews, interim staffing and an array of other business office services. If you are 
interested in knowing how the efficiency of your business office compares with demographically similar facilities, 
please complete the form below and return it to us by fax or email. In return, we will provide you with a 
benchmarking analysis. We will also make ourselves available for discussion and/or explanation of the data. 
Please complete the from below and fax to (303) 648-5589 or email to analysis@ereso.com. You may also 
complete this information online at http://www.ereso.com/benchmark/benchmark-indicator-analysis-form. Your 
information is confidential. 
Name 
Company 
Street Address 
City State Zip 
Phone Ext. Fax 
E-mail Address 
1. Bed Size 
2. Beds in Service 
3. Average Daily Census 
4. Total Accounts Receivable $ 
5. Cash Receipts per Month $ 
6. Gross Revenue per Month $ 
7. Accounts Receivable $ Over 90 days $ 
8. Monthly Cost of Admissions/Registration Staff (including benefit load) $ 
9. Monthly Cost of Business Office Staff (including benefit load) $ 
10. Administrative Write Off $ Per Month (not including contractuals) $ 
11. Bad Debt Write-Off $ per Month $ 
12. Charity Write-Off $ per Month $ 
13. Number of Open Accounts 
14. Number of FTEs in Business Office (excluding admissions) 
15. Percentage of AR in Self Pay > 90 days 
16. Number of Days of Cash on Hand 
17. Amount of $ Discharged But Not Final Billed (DNFB) $ 
18. When was your ChargeMaster last updated? (mm/dd/yy) 
19. Date Data Compiled (mm/dd/yy) 
20. What is your Patient Accounting System 
Please feel free to contact us with any questions. 
800.355.0410 
www.ereso.com
Benchmark Indicator Analysis (BIA) 
Category Descriptions 
1. Bed Size – The total # of licensed beds. 
2. Beds in Service – The total # of operational beds. 
3. Average Daily Census – The average daily inpatient census. 
4. Total Accounts Receivable – The total dollar amount of any open patient accounts where monies are 
owed the organization for services provided. This does not include accounts in bad debt status. 
5. Cash Receipts Per Month – The actual cash received by the organization as payment for services 
rendered on any patient accounts for the monthly reporting period. 
6. Gross Revenue Per Month – The total amount of charges on accounts for patient services rendered for 
the monthly reporting period. 
7. Accounts Receivable $ Over 90 days – The total dollar amount of all open accounts that are older than 
90 days. This does not include the accounts in bad debt status. 
8. Monthly Cost of Admissions/Registration Staff – the total of salaries/wages including benefit load (i.e. 
health benefits, payroll taxes, and other non-direct payroll costs) for ALL individuals (staff and 
management) that work in admissions/registration Admissions/registration staff and management 
includes but is not limited to: schedulers, insurance verifiers, financial counselors, pre-registrars, 
registrars, etc. and all supervisors, managers, and/or directors of this staff. 
9. Monthly Cost of Business Office Staff – the total of salaries/wages including benefit load (i.e. health 
benefits, payroll taxes, and other non-direct payroll costs) for ALL individuals (staff and management) 
that work in the Business Office. Business office staff and management includes but is not limited to: 
cash posters, refund specialists, billers, insurance and self-pay collectors, analysts, data entry, charge 
master specialist (based in business office), receptionists, customer service and all supervisors, managers, 
and/or directors of this staff. 
10. Administrative Write Off $ Per Month (not including contractuals) – the dollar amount of accounts that 
are written off to codes other than bad debt and charity. An example would be denied accounts that could 
not be overturned and will not be paid. 
11. Bad Debt Write Off $ Per Month – the dollar amount of accounts that are written off to bad debt. 
12. Charity Write Off $ Per Month – the dollar amount of accounts that have been approved and written off to 
charity care. 
13. Number of Open Accounts – Number of open accounts being worked by the business office. Do not 
include those accounts that have been assigned to outside collection agencies or specific financial classes 
that are assigned to an outsource vendor for follow up. 
14. Number of FTEs in Business Office (excluding admissions) – Active number of full time employees 
that are performing business office functions (i.e. management, supervisors, billers, collectors, posters, 
etc). 
15. Percentage of AR in Self Pay > 90 days – Dollar amount of self pay as a percentage of accounts 
receivable that are greater than 90 days old. Do not include any accounts that have been referred to an 
outside collection agency. This can be determined by taking the total dollars in AR > 90 that are self pay 
and dividing it by the total dollars in AR >90. 
16. Number of Days of Cash on Hand – This is the actual amount of cash on hand divided by average cash 
usage per day for hospital expenses. 
17. Amount of $ Discharged But Not Final Billed (DNFB) – Dollar amount of accounts on patients that have 
been discharged and the billing has not been sent. 
18. When was your ChargeMaster last updated? – The last date that your ChargeMaster was completely 
updated using the latest available code changes and respective pricing? 
19. Date Data Compiled – The date the information was compiled on your Information System. (i.e. These 
numbers are from my March Month End Data – so the date would be 3/31/12). 
20. What is your Patient Accounting System? – This is the hospital’s main Health Information System (i.e. 
Meditech, Dairyland, CPSI, Siemens’s, HBOC, HMS, etc). 
800.355.0410 
www.ereso.com
Benchmark Indicator Analysis 
Prepared: April 8, 2013 
Facility Name: Sample Hospital 
Your Information: 
Facility Bed Size: 250 
Average Daily Census: 41.9 
Total Accounts Receivable: $7,722,450 
Cash Receipts per Month: $1,808,374 
Gross Revenue per Month: $2,843,505 
A/R Over 90 Days: $3,840,899 
Monthly Cost of Admissions Office: $45,000 
Monthly Cost of B.O. (billing/collections): $40,000 
Write Offs per Month - Administrative: $135,675 
Write Offs per Month - Bad Debt: $207,817 
Write Offs per Month - Charity: $86,487 
Write Offs per Month - TOTAL: $429,979 
Number of Open Accounts: 9 ,250 
Percent A/R in Self Pay: 20.00% 
Discharged Not Final Billed: $1,500,000 
Data Provided: Enter Date Compiled 
Name of provider: Enter Contact Name 
For additional 
information: 
re|solution 
P.O. Box 270903 Robin Bradbury 
Louisville, CO 80027 CEO 
800.355.0410 303.318.4292 direct 
www.ereso.com robin@ereso.com
Sample Hospital 
81.47 
45.93 
39.18 
0 10 20 30 40 50 60 70 80 90 
Best Practices 
Peer Group Average 
Sample Hospital 
Gross Days in A/R Outstanding 
Cost to Collect per Dollar 
$0.047 
$0.023 
$0.014 
Best Practices 
Peer Group Average 
Sample Hospital 
$0.00 $0.01 $0.02 $0.03 $0.04 $0.05 $0.06 $0.07 $0.08 $0.09 $0.10 
7.31% 
1.50% 
2.23% 
0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 
Best Practices 
Peer Group Average 
Sample Hospital 
BAD DEBT Write-Offs as a Percentage of Revenue 
` 
3.04% 
0.60% 
1.08% 
0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 
Best Practices 
Peer Group Average 
Sample Hospital 
CHARITY Write-Offs as a Percentage of Revenue 
49.7% 
19.0% 
24.0% 
0% 10% 20% 30% 40% 50% 60% 70% 
Best Practices 
Peer Group Average 
Sample Hospital 
A/R Greater than 90 Days as a Percentage of Total A/R 
15.8 
10.1 
5.0 
0 2 4 6 8 10 12 14 16 18 
Best Practices 
Peer Group Average 
Sample Hospital 
Days in Discharged Not Final Billed
Opportunity Analysis 
Sample Hospital 
April 8, 2013 
Hospital Peer Group Difference Cash Opportunity 
AR Days Reduction 81 46 36 $2,142,599 
Days over 90 Reduction 49.7% 24.0% 25.8% $995,686 
DNFB Reduction 15.8 10.1 5.77 $347,542 
Cost to Collect Reduction $ 0.047 $ 0.023 $ 0.024 $272,318 
Bad DebtWrite off Reduction 7.3% 2.2% 5.1% $866,441 
Charity Write off Reduction 3.0% 1.1% 2.0% $334,663 
Hospital Best Practices Difference Cash Opportunity 
AR Days Reduction 81 39 42 $2,549,483 
Days over 90 Reduction 49.7% 19.0% 30.7% $1,186,817 
DNFB Reduction 15.8 5.0 10.83 $652,554 
Cost to Collect Reduction $ 0.047 $ 0.014 $ 0.033 $379,161 
Bad DebtWrite off Reduction 7.3% 1.5% 5.8% $990,987 
Charity Write off Reduction 3.0% 0.6% 2.4% $416,556
Overview 
The need 
Marshalltown Medical and Surgical 
Center needed help to identify key 
areas of opportunity to quickly 
improve cash flow. The facility wanted 
to identify all organizational and 
process changes required for best 
practice revenue cycle. 
The Solution 
Marshalltown Medical and Surgical 
Center deployed re|grip™ 
complemented by an experienced 
re|solution manager to identify missed 
opportunities for reimbursement while 
providing training to key staff and 
implementing sustainable and proven 
improvements to the facility’s 
processes. 
The Benefit 
Marshalltown Medical and Surgical 
Center with the re|grip™ assessment, 
assisted by re|solution, quickly billed 
over $2,500,000 in missed charges 
resulting in over $600,000 in 
additional cash for MMSC. 
Improvements to process, CDM 
and Charge Capture will ensure 
long term sustainability. 
Marshalltown Medical & 
Surgical Center finds additional 
cash 
An assessment and redesign of business processes combined 
with guaranteed cash results leads to improving staff 
understanding and skills, optimizing the revenue cycle 
Marshalltown Medical & Surgical Center (MMSC) is a 125 bed acute care 
facility nestled in the heart of Iowa. It is the only full-service medical 
center serving the community and surrounding areas. It provides more 
than 60,000 residents with 24 hour emergency care, a state-of-the-art 
Diagnostic Imaging department, Cardiac Catheterization Lab, 
Rehabilitation Center, and a host of outreach programs. MMSC also owns 
and operates four primary care medical clinics in Marshalltown, Conrad, 
State Center, and Toledo. Their mission is to create and continually 
improve services that respond to health care needs within the community. 
They are dedicated to teamwork, integrity, and providing compassionate 
quality care to patients and families. 
Safeguarding Community Services 
MMSC’s leadership, while focused on addressing the needs of the 
community they served, was concerned with the integrity of their revenue 
cycle. A lack of cash threatened their ability to meet the healthcare needs 
of their community. Facing the numerous challenges of current healthcare 
reform and the threat of decreased reimbursement for Medicare and 
Medicaid, MMSC needed to quickly identify areas in which they were 
missing opportunities for optimal reimbursement. 
Balancing Community and Revenue Cycle Integrity 
MMSC leadership selected re|solution to assess their current revenue 
cycle and offer recommendations for proven, scalable, improvements to 
revenue cycle performance and integrity. In keeping with their 
commitment to community and rural healthcare facilities, re|solution 
guaranteed to find more cash opportunities than the assessment cost or 
the difference would be refunded. The review was completed and 
recommendations for improving business and operational processes and 
specific key areas of opportunity to optimize reimbursement were 
presented to MMSC’s leadership. 
Todd Burch –COO for MMSC said, “re|solution’s Guaranteed Revenue 
Improvement Program was a huge success for our facility. While we 
appreciated the additional cash found and process improvements 
implemented, the real benefit was capturing more dollars for the same 
services going forward. re|solution was easy to work with and 
immediately put our staff at ease. Great program.” 
re|grip™
“re|solution’s Guaranteed 
Revenue Improvement Program 
was a huge success for our facility. 
While we appreciated the 
additional cash found and process 
improvements implemented, the 
real benefit was capturing more 
dollars for the same services going 
forward. re|solution was easy to 
work with and immediately put 
our staff at ease. Great program.” 
- Todd Burch – COO, Marshalltown 
Medical & Surgical Center 
A Solid Foundation Provides Sustainable Measureable 
Results 
MMSC leadership collaborated with re|solution following a full 
assessment and the identification of key areas of opportunity for 
additional billing assistance needed to move quickly in billing missed 
charges. The re|solution team, together with MMSC staff, identified and 
billed $2,500,000 in missed charges, resulting in $600,000 in much-needed 
additional cash for MMSC. 
As part of the re|grip program, re|solution professionals in partnership 
with the MMSC team, developed new processes and implemented tools 
the facility uses to create and sustain improvements. Along with billing 
assistance, re|solution performed the Charge Capture review, 
departmental training and education process, and a Chargemaster review 
to optimize reimbursement. The on-site, re|solution Project Manager 
provided resources, skills, and suggestions for process improvements to 
increase cash performance. 
re|solution provided a full scope of services during the Guaranteed 
Revenue Improvement Program: 
 Determined deficits and areas of improvement 
 Provided the resources, tools and training to increase staff 
knowledge, confidence and skills 
 Provided billing and collection of identified accounts to increase 
cash 
Guaranteed for Peace of Mind 
Locating unbilled charges and the education of MMSC’s staff while 
generating just over $600,000 in additional cash for the hospital is 
impressive, but more significant are the process improvements and the 
knowledge transferred to Marshalltown Medical & Surgical Center’s 
business office staff for long term sustainable results. 
For more information 
Visit us at www.ereso.com, or call us at 1.800.355.0410
Overview 
The need 
Dallam Hartley was facing serious 
financial impact from significant 
revenue cycle operational issues; 
revenues had declined, DNFB was 
unstable, and long standing coding 
issues and training needs had gone 
unaddressed. Deficits in staffing added 
to the challenging situation. 
The Solution 
In partnership with re|solution, Dallam 
Hartley deployed re|store™. 
re|solution placed a Revenue Cycle 
Manager onsite to assist with training 
current staff, securing additional 
staffing, stabilizing the DNFB and 
billing. The staff worked aggressively to 
meet milestone goals. 
The Benefit 
Dallam Hartley realized a net benefit of 
nearly $500,000, eliminated billing 
compliance exposure, and increased 
cash by approximately 4% on flat 
revenue. The engagement continues to 
focus on moving all key performance 
indicators even closer to best practice 
levels. Dallam Hartley has requested 
that re|solution also assume 
responsibility for clinic billing 
operations due to superior 
performance. 
Dallam-Harley Counties 
Hospital District increases cash 
and reduces expenses 
Insourcing partnership reduces billing and follow up costs, 
increases cash flow and compliance, providing the benefits of 
outsourcing without eliminating staff or taking processes 
offsite. 
Dallam Hartley Counties Hospital District (DHCHD) is located in the 
northwest corner of the Lone Star state and is committed to being the 
primary quality healthcare resource for Dallam-Hartley counties and the 
surrounding areas. DHCHD is a 25-bed acute care facility offering Level IV 
trauma services, inpatient and outpatient services, 24-hour emergency 
room, surgery, nursing, laboratory and radiology. They are dedicated to 
excellence in patient care, offering a wide spectrum of clinical expertise, 
supported by an exceptional range of technology and staff. 
Ensuring Community Services 
Like many rural and community providers, DHCHD faced serious financial 
impact from significant revenue cycle operational issues. Executive 
leadership recognized that staffing deficits, new and changing healthcare 
regulations, economic challenges, a lack of billing and compliance training 
and coding issues were directly impacting cash. They were seeking a 
meaningful long term solution to decrease waste and improve efficiency. 
Executive Leadership reviewed a variety of options to quickly and 
positively resolve operational issues and improve cash flow. They 
determined partnering with re|solution for a full insource with 
transparent pricing would best support these goals. 
Making a Smooth Transition 
DHCHD’s leadership and re|solution collaborated to create an 
Engagement Management Action Plan for an efficient insource transition. 
The plan outlined a variety of milestones and goals designed to optimize 
revenue cycle operations. DHCHD employees were transitioned to 
re|solution, retaining jobs in the community. 
Leroy Schaffner – CEO for DHCHD said, “re|solution’s focus on process 
improvement and best practices has improved and streamlined our billing 
and follow-up, while at the same time increasing our cash flow.” 
re|store™
“re|solution started the project and 
quickly assessed our operation. 
Then they created a comprehensive 
management action plan to 
address the issues they found and 
drive improvements. Their 
monthly reporting package is great 
and we’re seeing data and analyses 
that we’ve never had access to 
before. They implemented their 
claims management technology 
which helped to increase cash 
collections for us. They also 
brought in other revenue cycle 
experts (coders, charge capture 
specialists, etc.) as needed to help 
train our staff. We’re very happy 
with re|solution and greatly value 
our partnership with them.” 
- Donny Pettit– CFO, Dallam Hartley 
Counties Hospital District 
Quickly deploying productivity initiatives and training 
creates a solid foundation for future performance 
While a typical outsource removes jobs from the community and does 
nothing to reduce expenditures, re|store™ insourcing eliminates these 
dilemmas. re|solution assumed responsibility for the day to day 
operations and immediately began work on implementing the 
Engagement Management Action Plan. An experienced re|solution 
revenue cycle manager was placed onsite to support training and 
mentoring the current staff and also took responsibility for managing the 
additional re|solution team brought on-site to assist in swiftly improving 
cash flow. 
Highlights of the best practice plan included: 
 Immediate compliance training/testing to staff 
 Reduce and stabilize DNFB 
 Resolve long standing coding issues 
 Conduct a charge capture review 
 Train ER registrars and clinic staff 
 Revise Self-pay letters and statements 
 Implementation of re|discover claims management technology 
Guaranteed Performance – Peace of Mind 
re|solution quickly provided additional staff upon transition to ensure 
revenue cycle improvements proceeded quickly. The business office staff 
immediately completed compliance and billing training and testing 
eliminating billing compliance exposure by utilizing best practices. Cash 
increased nearly 4% on flat revenue. 
re|solution collected additional cash and DHCHD realized a net benefit of 
nearly $500,000. DHCHD has requested that re|solution also assume 
responsibility for clinic billing operations due to superior performance. 
The engagement continues to focus on moving all key performance 
indicators even closer to best practice levels. 
For more information 
Visit us at www.ereso.com, or call us at 1.800.355.0410
Overview 
The need 
An outstanding AR of $2,926,000, of 
which $1,179,000 was over 90 days 
and Gross Days in AR exceeding 117, 
Muenster Memorial needed help to 
reduce their AR. Another immediate 
need was to address Discharged Not 
Final Billed (DNFB) which had climbed 
to $735,000 or nearly 29 days of gross 
revenue. 
The Solution 
Muenster Memorial deployed 
re|cover™ complemented by an 
experienced re|solution manager to 
assist in assessing staff, providing 
training and re|solution tools left 
behind for ongoing improvement and 
success. 
The Benefit 
Muenster Memorial with processes 
implemented by re|solution’s 
experienced staff and use of 
proprietary tools reduced their AR 
over 90 days from $1,179,000 to 
$474,000 and DNFB decreased from 29 
days of gross revenue to 5 days, an 
83% reduction. The AR clean-up 
generated over $700,000 in cash 
collections while the DNFB reduction 
accelerated another $300,000 in cash 
for the hospital, and increase of over 
$1MM in an 18 bed facility 
Muenster Memorial Hospital 
achieves a significant reduction 
of Accounts Receivable and 
DNFB 
Assessment, training and a reduction in Accounts Receivable 
completed, increasing both staff confidence and performance. 
Muenster Memorial is an 18 bed, Critical Access Hospital located in Cooke 
County, Texas. Since 1964, MMH has served Muenster and surrounding 
communities with the same philosophy; the value of patient care depends 
on the outcomes achieved and resources used. MMH’s dedication to serve 
the community with integrity, compassion, public service, efficiency, and 
support create an atmosphere of trust, and open communication. 
The Muenster Hospital District’s staff and Board are driven by a vision to 
work with the community to provide total healthcare needs as well as to 
inform and educate to improve the wellness of the community. 
Ensuring Community Services 
Like many Critical Access healthcare providers today, MMH faced an 
immediate need to reduce $2,926,000 in Accounts Receivable of which 
$1,179,000 was over 90 days with Gross Days in AR exceeding 117. 
Addressing the Discharged Not Final Billed (DNFB) which had climbed to 
an unacceptable amount, nearly 29 days of gross revenue had become 
critical. MMH’s Board and leadership determined that to accomplish these 
goals they needed to improve organizational structure, identify staff 
deficits and implement a training program to address working procedures 
and standards while quickly reducing the AR and DNFB. They realized that 
changes were needed to ensure their continued success in Cooke County. 
Balancing Community and Revenue Cycle Integrity 
Needing immediate improvement, leadership partnered with re|solution 
to assess the situation, provide training and improve processes while 
augmenting MMH staff to reduce the nearly 3MM in outstanding AR and 
minimizing bad debt. Providing local staff with additional training kept 
jobs in the community while increasing employee skills and confidence. 
Lynn Heller – Former CEO for MMH said, “Our accounts receivable had 
grown to a level that was unmanageable by our staff. My options were to 
hire additional staff or bring in someone who knew what needed to be 
done, and had the expertise to get it done. The return on investment has 
been outstanding. A major benefit was to reduce the volume of accounts 
receivable accounts to a level that is manageable by our staff. Of course, 
collecting a bucket full of additional payments has been good too!” 
re|cover™
“Our accounts receivable had 
grown to a level that was 
unmanageable by our staff. My 
options were to hire additional staff 
or bring in someone who knew 
what needed to be done, and had 
the expertise to get it done. The 
return on investment has been 
outstanding. A major benefit was 
to reduce the volume of accounts 
receivable accounts to a level that is 
manageable by our staff. Of course, 
collecting a bucket full of 
additional payments has been good 
too!” 
- Lynn Heller – Former CEO, Muenster 
Memorial Hospital 
A Solid Foundation through Training, Mentoring and 
Proprietary Tools is Key to Measureable Sustainable Results 
MMH leadership worked closely with re|solution focusing on each item 
identified to make the necessary improvements. An experienced 
re|solution project manager (RPM) was placed onsite to assist in training 
and mentoring the current MMH staff and also took responsibility for 
managing the additional re|solution team brought on-site to assist in the 
critical cash acceleration project. re|solution immediately began work on 
implementing improvements, providing the resources, skills, and 
processes necessary to quickly increase cash performance. 
The goal was to reduce accounts receivable as quickly as possible and to 
provide the guidance and tools necessary for MMH to measure staff 
productivity and create sustain improvements. 
re|solution provided a full scope of services during the cash acceleration: 
 Interviewing leadership and staff to determine deficits 
 Providing the resources, tools and training to increase staff 
knowledge, confidence and skills 
 Collecting on assigned accounts to quickly decrease aged accounts 
receivable 
 Reducing the DNFB for additional cash 
Guaranteed Performance – Peace of Mind 
Reduction of MMH’s AR over 90 days from $1,179,000 to $474,000 and 
DNFB decreased from 29 days of gross revenue to just 5 days, an 83% 
reduction, generating just over $1,000,000 in cash for the hospital. The 
improved performance indicators are impressive, but more significant are 
the process improvements and the knowledge transferred to Muenster 
Memorial’s business office staff. 
For more information 
Visit us at www.ereso.com, or call us at 1.800.355.0410

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Rural and Community Hospital Services

  • 1. The road to CASH isn’t paved with good intentions…
  • 2. The road to CASH is paved with ACTION! At re|solution, we’ve built our reputation on more than a decade of improving revenue cycle operations for healthcare providers throughout the country. We provide revenue cycle process and technology solutions that result in both immediate and sustainable improvements to a provider’s cash flow, profitability and revenue cycle efficiency. In addition to finding the cash that falls through the cracks in revenue cycle and billing processes, our on-site approach establishes a knowledgeable and confident business office staff that operates with greater efficiency, higher productivity and better financial results. Just as healthcare itself must meet the specific needs of each patient, re|solution offers a full spectrum of revenue cycle services – customized to meet the unique needs and constraints of each of our clients in the communities they serve. re|solution’s technology solutions and its renowned educational, mentoring approach can improve every aspect of your revenue cycle. We are proud to say that we have provided an overall net CASH gain to every one of our clients. • Poor cash flow? • Days of cash on hand < 20 days? • High AR over 90 days? • Recent loss of key personnel? • Lack of qualified and/or experienced personnel? • Cost to collect higher than 3%? • Recent system conversion? • APC Index < 3.0? symptoms
  • 3. • Revenue Cycle Assessment • Cash Acceleration • Interim Staffing • Virtual Business Office Outsourcing • Reimbursement Review • Self Pay Management • Charge Capture Review tre a tm e nts su s ta i na b l e cu re • Cash is up • Receivable days down • Increased reimbursement • Education and mentoring of staff on-site • Improved processes and procedures • Roadmap for long-term success • Peace of mind Call re|solution today at 1.800.355.0410 For a FREE Benchmark Indicator Analysis, visit us at www.ereso.com
  • 4. re|solution provides highly effective, tailored solutions to the business challenges faced by hospitals, outpatient facilities, physician practices, clinics, DME and home health providers. 363 centennial pkwy – suite 105, louisville CO 80027 • phone 303.530.0396 • toll free 800.355.0410 • www.ereso.com
  • 5. Map of Engagements At re|solution, we’ve built our reputation on more than a decade of improving revenue cycle operations for healthcare providers throughout the country. We provide revenue cycle process and technology solutions that result in both immediate and sustainable improvements to a provider’s cash flow, profitability and revenue cycle efficiency. In addition to finding the cash that falls through the cracks, our on-site approach establishes a knowledgeable and confident staff that operates with greater efficiency, higher productivity and better financial results. Visit us at www.ereso.com.
  • 6. rree||ccoovveerr CCCaaassshhh AAAcccccceeellleeerrraaatttiiiooonnn IIImmmmmmeeedddiiiaaattteee CCCaaassshhh Other benefits include:  Reduced days in A/R  Improved bottom line  On-site training  Proprietary reporting tools  Improved management information  Sustainable results  Peace of mind RRReeeaaalll LLLiiifffeee RRReeesssuuullltttsss “The re|solution team was so helpful and had so many good ideas that they quick-ly gained the trust of the full-time staff. Everyone was happy to have them on board and soon realized the value of their expertise.” John Wilker, Chief Financial Officer Portneuf Medical Center Carson Tahoe Regional Medical Center (“CTRMC”) is a 140 bed facility just south of Reno, Nevada. With over 30,000 patient visits per year, CTRMC had a negative adjustment to their net Accounts Receivable of nearly $6,000,000 when their management embarked on a process to find any and all opportunities for cash and bottom line improvement. re|solution was engaged and assigned all insurance accounts over 90 days. During the first quar-ter of the engagement, cash collections were 40% higher than cash collections for the same quarter in the prior year. In addition, re|solution provided added services for CTRMC’s business office staff, such as training in billing and follow-up techniques and a detailed revenue cycle assessment at no additional cost. The hospital administration was ecstatic about the increased cash flow. The improvements identi-fied and implemented by re|solution were continued after the engagement ended. MMMeeettthhhooodddooolllooogggyyy  Experienced and knowledgeable analysts work your aged accounts  On-site training and mentoring of your staff insures long-term improvements  Inefficiencies identified and recommendations made for customized process improvements  Safety net of re|solution resources provide post engagement support  Post engagement quarterly benchmark reports verify your success For additional information: info@ereso.com toll free 800-355-0410 www.ereso.com
  • 7. rrreee|||sssooouuurrrccceee IIInnnttteeerrriiimmm SSStttaaaffffffiiinnnggg IIImmmmmmeeedddiiiaaattteee AAAcccccceeessssss tttooo PPPrrrooovvveeennn,,, QQQuuuaaallliiifffiiieeeddd PPPeeerrrsssooonnnnnneeelll Other benefits include:  Cash increases with improved staff skills  On-site knowledge transfer produces competent local employees  On-site training/mentoring increases skill retention  Temporary or long-term placements RRReeeaaalll LLLiiifffeee RRReeesssuuullltttsss “Your placement of an interim busi-ness office manager helped us begin the process of implementing the rec-ommendations Lavaca Medical Center (“LCMC”) is a 25-bed community hospital in south central Texas providing a wide range of inpatient and outpatient services. LCMC’s business office manager resigned. Months of searching for a replacement resulted in no qualified candidates, so LCMC identified an individual from another department to become the new business office manager. re|solution was engaged to mentor/train the individual selected. During the first three months of the engagement, the on-site re|solution interim business office manager managed the business office while the new business office manager shadowed and learned effective business office manage-ment. During the second three months, the new business office manager managed the business office and the on-site re|solution interim business office manager provided support while writing policies and creating a reporting structure. During the six month engagement, LCMC also underwent a difficult system conversion. Cash remained relatively steady even with the turnover and system conversion problems. The new busi-ness office manager received continued support from the re|solution interim business office manager who remained a resource after the training/mentoring engagement ended. MMMeeettthhhooodddooolllooogggyyy  You select from our elite reserve of qualified personnel  Mentoring option for training managers or higher level personnel  Implementation of unique reporting and productivity tools with monthly reports to measure employee performance  Safety net of re|solution resources provide post engagement support made in your assess-ment. Your continued support in the months following the engagement, including assistance in interviewing candidates for the permanent busi-ness office manager, enabled us to put the blocks in place during this transitional period as we worked to-ward long-term stability.” Bob Ellzey, President/CEO Laird Memorial Hospital For additional information: info@ereso.com toll free 800-355-0410 www.ereso.com
  • 8. rrreee|||wwwiiinnnddd SSSyyysssttteeemmm CCCooonnnvvveeerrrsssiiiooonnn AAA///RRR WWWiiinnnddd DDDooowwwnnn OOOvvveeerrrvvviiieeewww Your new system conversion date is nearly here. You and your leadership team and staff have dedicated a large amount of time to implementation, planning and training while at the same time trying to maintain current operations. System implementations are complex and at times can be overwhelming, and despite your best efforts, key performance indicators can begin to move in the wrong direction. CCChhhaaalllllleeennngggeee You and your staff are working hard, but…  Cash collections are decreasing  A/R days are increasing  Your staff is having difficulty completing their current work while building and training on the new system  Key managers are required to dedicate time preparing for the implementation  There is pressure to retire your old legacy system early to reduce costs SSSooollluuutttiiiooonnn re|solution’s System Conversion A/R Wind Down (re|wind) solution combines our highly trained staff, with proven experience in A/R liquidation and cash acceleration during system conversions, with the efforts of your staff. Our re|wind solution creates a synergy that:  Provides a cost effective alternative to working your post conversion A/R internally  Ensures that your pre and post conversion cash collections remain at or exceed current performance  Allows your revenue cycle leadership and key personnel to focus on successful implementation and training RRReeesssuuullltttsss Maintaining pre-conversion performance in cash collections, A/R, and bad debt expense is the key to an effec-tive and ultimately successful system conversion. Our re|wind solution will deliver the following results:  Significantly increases the likelihood of a successful system conversion  Consistent cash collections before, during, and immediately after the conversion  Assists with maintaining other key revenue cycle performance indicators at current levels  Potential reduction of system maintenance costs by early retirement of old legacy system For additional information: info@ereso.com toll free 800-355-0410 www.ereso.com
  • 9. rree||ttrraaiinn TTTrrraaaiiinnniiinnnggg aaannnddd MMMeeennntttooorrriiinnnggg IIImmmppprrrooovvveeeddd SSSkkkiiillllllsss IIInnncccrrreeeaaassseee CCCaaassshhh Other benefits include:  Training provided by highly skilled revenue cycle management experts  On-site, one-on-one training insures retention  Create well-trained staff without recruiting new personnel  Application of proprietary software to monitor employee progress and performance  Sustainable business office process improvement TTTrrraaaiiinnniiinnnggg PPPrrrooogggrrraaammm re|train is a cost-effective way to provide new or less experienced business office staff and manage-ment with receivables management skills. The service is conveyed one-on-one by a re|solution revenue cycle operations expert. Throughout the training, your staff completes a series of written and oral exercises to verify comprehension and retention of the material. re|solution also applies proprietary software to monitor employee performance. MMMeeettthhhooodddooolllooogggyyy  Review and compare your facility’s key revenue cycle indicators to those of best practice organizations, with instructions on how to use benchmarking to monitor, manage and improve business office performance  A re|solution revenue cycle operations expert will provide in-depth instruction on:  Bad debt and contractual reserves  A/R management influences on the income statement and balance sheet  Determining if changes in A/R are due to revenue fluctuations or process breakdowns  Understanding the causes of key indicator variances and options for corrective actions  Utilizing the Aged Trial Balance and other reports as management tools  Create a responsibility matrix that optimizes the skills of individual staff members in assignment of key business office functions and processes  Develop performance expectations and productivity standards including prioritizing tasks and developing effective time management strategies. Apply proprietary re|solution management tools and motivational techniques to improve revenue cycle performance  Daily performance tracking, monthly site visits or calls to review progress and answer questions.  Verbal exit conference and written report for hospital senior management at the conclusion of the engagement For additional information: info@ereso.com toll free800-355-0410 www.ereso.com
  • 10. re|store Insourced Business Office Guaranteed Performance Improvement Other benefits include:  Transparent pricing—no surprises  Guaranteed bottom line increase  No more staffing issues  Improved dashboard reporting  Implementation of new technology  Peace of mind Real Life Results “We had been without a business office manager and our issues were severe. The transition was relatively easy, and the results practically immediate. re|solution took over only the necessary positions, trained those we desired to have stay, and the billing office began to function efficiently. I can’t say enough good things about our experience with re|solution” Mike Click, CEO Brownfield Regional Medical Center When Brownfield Regional Medical Center (“BRMC”) in NW Texas engaged re|solution, BRMC’s AR days were at 131, compared to a peer average of 48 days, days of unbilled AR was at 27 compared to the peer average of only 10, and total AR was at $4.5 million. re|solution was selected to “insource” the business office by hiring all BRMC employees and placing a seasoned business office manager to lead the revenue cycle. re|solution assumed responsibility for BRMC’s 21 revenue cycle employees. During the re|store engagement, re|solution reduced the outstanding AR to less than $2 million and decreased the total business office staff needed to run the operation by implementing process improvement and increasing operating efficiencies. After several years, re|solution assisted BRMC in returning to an in-house Business Office once operations were stabilized and BRMC desired to bring the work back in-house. Methodology  All costs of the revenue cycle assumed by re|solution including cost of other revenue cycle vendors  Pricing set at current costs plus 10%  Guarantee that additional reimbursement will exceed 100% of additional costs or contract may be terminated  Manage and train current staff  Optimize current patient accounting system  New technology introduced to improve reimbursement  Monthly accountability, productivity and benchmarking reports For additional information: info@ereso.com toll free 800-355-0410 www.ereso.com
  • 11. rree||ggrriipp GGGuuuaaarrraaannnttteeeeeeddd RRReeevvveeennnuuueee IIImmmppprrrooovvveeemmmeeennnttt PPPrrrooogggrrraaammm OOOvvveeerrrvvviiieeewww Using a comprehensive initial assessment of the revenue cycle, re|solution identifies areas where the facility has not received the reimbursement for which it is entitled. The assessment looks at all phases of the revenue cycle including: scheduling, registration, charge capture, coding, billing, collections and reimbursement. The assessment will identify claims to be rebilled, changes in pro-cess that will generate additional dollars and other opportunities to move towards a best practices revenue cycle. re|solution guarantees that the cost of the assessment will be covered by opportu-nities found for additional reimbursement. Once the initial assessment is completed, re|solution works with two departments each quarter to assist them in improving charge capture, documentation and coding practices to insure that the facility is being paid the correct amount for all services that are performed. In addition, for a year following the assessment, re|solution will monitor the implementation of each recommendation to insure effective implementation. Once again, re|solution guarantees that the cost of this quarterly implementation and monitoring is covered by additional reimbursement. CCChhhaaalllllleeennngggeee The challenges faced by rural and community hospitals are enormous. The same charge capture, coding and reimbursement issues that plague larger facilities also affect rural and community hospitals with less resources to insure compliance and appropriate reimbursement for services provided. re|solution’s re|grip program provides a safety net to insure that the provider receives all the monies they are due. BBBeeennneeefffiiitttsss Using proprietary technology, interviews and a proven continuous improvement and monitoring pro-cess, this no-risk program allows personnel at the departmental level to work with the revenue cycle personnel in optimizing reimbursement. This is the key to an effective revenue cycle when you can get the clinicians and the business people working together. The process also allows the facility to explore other opportunities for improvement such as point of service collections, denial manage-ment, self pay management, contract payment review and EHR implementation for meaningful use. This safety net gives our clients the peace of mind that all services are being reimbursed at an ap-propriate level. For additional information: info@ereso.com toll free 800-355-0410 www.ereso.com
  • 12. Benchmark Indicator Analysis How does your facility compare nationally with other facilities of your respective size? re|solution is a hospital expert, providing superior accounts receivable management, revenue cycle analysis, training, APC and CDM reviews, interim staffing and an array of other business office services. If you are interested in knowing how the efficiency of your business office compares with demographically similar facilities, please complete the form below and return it to us by fax or email. In return, we will provide you with a benchmarking analysis. We will also make ourselves available for discussion and/or explanation of the data. Please complete the from below and fax to (303) 648-5589 or email to analysis@ereso.com. You may also complete this information online at http://www.ereso.com/benchmark/benchmark-indicator-analysis-form. Your information is confidential. Name Company Street Address City State Zip Phone Ext. Fax E-mail Address 1. Bed Size 2. Beds in Service 3. Average Daily Census 4. Total Accounts Receivable $ 5. Cash Receipts per Month $ 6. Gross Revenue per Month $ 7. Accounts Receivable $ Over 90 days $ 8. Monthly Cost of Admissions/Registration Staff (including benefit load) $ 9. Monthly Cost of Business Office Staff (including benefit load) $ 10. Administrative Write Off $ Per Month (not including contractuals) $ 11. Bad Debt Write-Off $ per Month $ 12. Charity Write-Off $ per Month $ 13. Number of Open Accounts 14. Number of FTEs in Business Office (excluding admissions) 15. Percentage of AR in Self Pay > 90 days 16. Number of Days of Cash on Hand 17. Amount of $ Discharged But Not Final Billed (DNFB) $ 18. When was your ChargeMaster last updated? (mm/dd/yy) 19. Date Data Compiled (mm/dd/yy) 20. What is your Patient Accounting System Please feel free to contact us with any questions. 800.355.0410 www.ereso.com
  • 13. Benchmark Indicator Analysis (BIA) Category Descriptions 1. Bed Size – The total # of licensed beds. 2. Beds in Service – The total # of operational beds. 3. Average Daily Census – The average daily inpatient census. 4. Total Accounts Receivable – The total dollar amount of any open patient accounts where monies are owed the organization for services provided. This does not include accounts in bad debt status. 5. Cash Receipts Per Month – The actual cash received by the organization as payment for services rendered on any patient accounts for the monthly reporting period. 6. Gross Revenue Per Month – The total amount of charges on accounts for patient services rendered for the monthly reporting period. 7. Accounts Receivable $ Over 90 days – The total dollar amount of all open accounts that are older than 90 days. This does not include the accounts in bad debt status. 8. Monthly Cost of Admissions/Registration Staff – the total of salaries/wages including benefit load (i.e. health benefits, payroll taxes, and other non-direct payroll costs) for ALL individuals (staff and management) that work in admissions/registration Admissions/registration staff and management includes but is not limited to: schedulers, insurance verifiers, financial counselors, pre-registrars, registrars, etc. and all supervisors, managers, and/or directors of this staff. 9. Monthly Cost of Business Office Staff – the total of salaries/wages including benefit load (i.e. health benefits, payroll taxes, and other non-direct payroll costs) for ALL individuals (staff and management) that work in the Business Office. Business office staff and management includes but is not limited to: cash posters, refund specialists, billers, insurance and self-pay collectors, analysts, data entry, charge master specialist (based in business office), receptionists, customer service and all supervisors, managers, and/or directors of this staff. 10. Administrative Write Off $ Per Month (not including contractuals) – the dollar amount of accounts that are written off to codes other than bad debt and charity. An example would be denied accounts that could not be overturned and will not be paid. 11. Bad Debt Write Off $ Per Month – the dollar amount of accounts that are written off to bad debt. 12. Charity Write Off $ Per Month – the dollar amount of accounts that have been approved and written off to charity care. 13. Number of Open Accounts – Number of open accounts being worked by the business office. Do not include those accounts that have been assigned to outside collection agencies or specific financial classes that are assigned to an outsource vendor for follow up. 14. Number of FTEs in Business Office (excluding admissions) – Active number of full time employees that are performing business office functions (i.e. management, supervisors, billers, collectors, posters, etc). 15. Percentage of AR in Self Pay > 90 days – Dollar amount of self pay as a percentage of accounts receivable that are greater than 90 days old. Do not include any accounts that have been referred to an outside collection agency. This can be determined by taking the total dollars in AR > 90 that are self pay and dividing it by the total dollars in AR >90. 16. Number of Days of Cash on Hand – This is the actual amount of cash on hand divided by average cash usage per day for hospital expenses. 17. Amount of $ Discharged But Not Final Billed (DNFB) – Dollar amount of accounts on patients that have been discharged and the billing has not been sent. 18. When was your ChargeMaster last updated? – The last date that your ChargeMaster was completely updated using the latest available code changes and respective pricing? 19. Date Data Compiled – The date the information was compiled on your Information System. (i.e. These numbers are from my March Month End Data – so the date would be 3/31/12). 20. What is your Patient Accounting System? – This is the hospital’s main Health Information System (i.e. Meditech, Dairyland, CPSI, Siemens’s, HBOC, HMS, etc). 800.355.0410 www.ereso.com
  • 14. Benchmark Indicator Analysis Prepared: April 8, 2013 Facility Name: Sample Hospital Your Information: Facility Bed Size: 250 Average Daily Census: 41.9 Total Accounts Receivable: $7,722,450 Cash Receipts per Month: $1,808,374 Gross Revenue per Month: $2,843,505 A/R Over 90 Days: $3,840,899 Monthly Cost of Admissions Office: $45,000 Monthly Cost of B.O. (billing/collections): $40,000 Write Offs per Month - Administrative: $135,675 Write Offs per Month - Bad Debt: $207,817 Write Offs per Month - Charity: $86,487 Write Offs per Month - TOTAL: $429,979 Number of Open Accounts: 9 ,250 Percent A/R in Self Pay: 20.00% Discharged Not Final Billed: $1,500,000 Data Provided: Enter Date Compiled Name of provider: Enter Contact Name For additional information: re|solution P.O. Box 270903 Robin Bradbury Louisville, CO 80027 CEO 800.355.0410 303.318.4292 direct www.ereso.com robin@ereso.com
  • 15. Sample Hospital 81.47 45.93 39.18 0 10 20 30 40 50 60 70 80 90 Best Practices Peer Group Average Sample Hospital Gross Days in A/R Outstanding Cost to Collect per Dollar $0.047 $0.023 $0.014 Best Practices Peer Group Average Sample Hospital $0.00 $0.01 $0.02 $0.03 $0.04 $0.05 $0.06 $0.07 $0.08 $0.09 $0.10 7.31% 1.50% 2.23% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% Best Practices Peer Group Average Sample Hospital BAD DEBT Write-Offs as a Percentage of Revenue ` 3.04% 0.60% 1.08% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% Best Practices Peer Group Average Sample Hospital CHARITY Write-Offs as a Percentage of Revenue 49.7% 19.0% 24.0% 0% 10% 20% 30% 40% 50% 60% 70% Best Practices Peer Group Average Sample Hospital A/R Greater than 90 Days as a Percentage of Total A/R 15.8 10.1 5.0 0 2 4 6 8 10 12 14 16 18 Best Practices Peer Group Average Sample Hospital Days in Discharged Not Final Billed
  • 16. Opportunity Analysis Sample Hospital April 8, 2013 Hospital Peer Group Difference Cash Opportunity AR Days Reduction 81 46 36 $2,142,599 Days over 90 Reduction 49.7% 24.0% 25.8% $995,686 DNFB Reduction 15.8 10.1 5.77 $347,542 Cost to Collect Reduction $ 0.047 $ 0.023 $ 0.024 $272,318 Bad DebtWrite off Reduction 7.3% 2.2% 5.1% $866,441 Charity Write off Reduction 3.0% 1.1% 2.0% $334,663 Hospital Best Practices Difference Cash Opportunity AR Days Reduction 81 39 42 $2,549,483 Days over 90 Reduction 49.7% 19.0% 30.7% $1,186,817 DNFB Reduction 15.8 5.0 10.83 $652,554 Cost to Collect Reduction $ 0.047 $ 0.014 $ 0.033 $379,161 Bad DebtWrite off Reduction 7.3% 1.5% 5.8% $990,987 Charity Write off Reduction 3.0% 0.6% 2.4% $416,556
  • 17. Overview The need Marshalltown Medical and Surgical Center needed help to identify key areas of opportunity to quickly improve cash flow. The facility wanted to identify all organizational and process changes required for best practice revenue cycle. The Solution Marshalltown Medical and Surgical Center deployed re|grip™ complemented by an experienced re|solution manager to identify missed opportunities for reimbursement while providing training to key staff and implementing sustainable and proven improvements to the facility’s processes. The Benefit Marshalltown Medical and Surgical Center with the re|grip™ assessment, assisted by re|solution, quickly billed over $2,500,000 in missed charges resulting in over $600,000 in additional cash for MMSC. Improvements to process, CDM and Charge Capture will ensure long term sustainability. Marshalltown Medical & Surgical Center finds additional cash An assessment and redesign of business processes combined with guaranteed cash results leads to improving staff understanding and skills, optimizing the revenue cycle Marshalltown Medical & Surgical Center (MMSC) is a 125 bed acute care facility nestled in the heart of Iowa. It is the only full-service medical center serving the community and surrounding areas. It provides more than 60,000 residents with 24 hour emergency care, a state-of-the-art Diagnostic Imaging department, Cardiac Catheterization Lab, Rehabilitation Center, and a host of outreach programs. MMSC also owns and operates four primary care medical clinics in Marshalltown, Conrad, State Center, and Toledo. Their mission is to create and continually improve services that respond to health care needs within the community. They are dedicated to teamwork, integrity, and providing compassionate quality care to patients and families. Safeguarding Community Services MMSC’s leadership, while focused on addressing the needs of the community they served, was concerned with the integrity of their revenue cycle. A lack of cash threatened their ability to meet the healthcare needs of their community. Facing the numerous challenges of current healthcare reform and the threat of decreased reimbursement for Medicare and Medicaid, MMSC needed to quickly identify areas in which they were missing opportunities for optimal reimbursement. Balancing Community and Revenue Cycle Integrity MMSC leadership selected re|solution to assess their current revenue cycle and offer recommendations for proven, scalable, improvements to revenue cycle performance and integrity. In keeping with their commitment to community and rural healthcare facilities, re|solution guaranteed to find more cash opportunities than the assessment cost or the difference would be refunded. The review was completed and recommendations for improving business and operational processes and specific key areas of opportunity to optimize reimbursement were presented to MMSC’s leadership. Todd Burch –COO for MMSC said, “re|solution’s Guaranteed Revenue Improvement Program was a huge success for our facility. While we appreciated the additional cash found and process improvements implemented, the real benefit was capturing more dollars for the same services going forward. re|solution was easy to work with and immediately put our staff at ease. Great program.” re|grip™
  • 18. “re|solution’s Guaranteed Revenue Improvement Program was a huge success for our facility. While we appreciated the additional cash found and process improvements implemented, the real benefit was capturing more dollars for the same services going forward. re|solution was easy to work with and immediately put our staff at ease. Great program.” - Todd Burch – COO, Marshalltown Medical & Surgical Center A Solid Foundation Provides Sustainable Measureable Results MMSC leadership collaborated with re|solution following a full assessment and the identification of key areas of opportunity for additional billing assistance needed to move quickly in billing missed charges. The re|solution team, together with MMSC staff, identified and billed $2,500,000 in missed charges, resulting in $600,000 in much-needed additional cash for MMSC. As part of the re|grip program, re|solution professionals in partnership with the MMSC team, developed new processes and implemented tools the facility uses to create and sustain improvements. Along with billing assistance, re|solution performed the Charge Capture review, departmental training and education process, and a Chargemaster review to optimize reimbursement. The on-site, re|solution Project Manager provided resources, skills, and suggestions for process improvements to increase cash performance. re|solution provided a full scope of services during the Guaranteed Revenue Improvement Program:  Determined deficits and areas of improvement  Provided the resources, tools and training to increase staff knowledge, confidence and skills  Provided billing and collection of identified accounts to increase cash Guaranteed for Peace of Mind Locating unbilled charges and the education of MMSC’s staff while generating just over $600,000 in additional cash for the hospital is impressive, but more significant are the process improvements and the knowledge transferred to Marshalltown Medical & Surgical Center’s business office staff for long term sustainable results. For more information Visit us at www.ereso.com, or call us at 1.800.355.0410
  • 19. Overview The need Dallam Hartley was facing serious financial impact from significant revenue cycle operational issues; revenues had declined, DNFB was unstable, and long standing coding issues and training needs had gone unaddressed. Deficits in staffing added to the challenging situation. The Solution In partnership with re|solution, Dallam Hartley deployed re|store™. re|solution placed a Revenue Cycle Manager onsite to assist with training current staff, securing additional staffing, stabilizing the DNFB and billing. The staff worked aggressively to meet milestone goals. The Benefit Dallam Hartley realized a net benefit of nearly $500,000, eliminated billing compliance exposure, and increased cash by approximately 4% on flat revenue. The engagement continues to focus on moving all key performance indicators even closer to best practice levels. Dallam Hartley has requested that re|solution also assume responsibility for clinic billing operations due to superior performance. Dallam-Harley Counties Hospital District increases cash and reduces expenses Insourcing partnership reduces billing and follow up costs, increases cash flow and compliance, providing the benefits of outsourcing without eliminating staff or taking processes offsite. Dallam Hartley Counties Hospital District (DHCHD) is located in the northwest corner of the Lone Star state and is committed to being the primary quality healthcare resource for Dallam-Hartley counties and the surrounding areas. DHCHD is a 25-bed acute care facility offering Level IV trauma services, inpatient and outpatient services, 24-hour emergency room, surgery, nursing, laboratory and radiology. They are dedicated to excellence in patient care, offering a wide spectrum of clinical expertise, supported by an exceptional range of technology and staff. Ensuring Community Services Like many rural and community providers, DHCHD faced serious financial impact from significant revenue cycle operational issues. Executive leadership recognized that staffing deficits, new and changing healthcare regulations, economic challenges, a lack of billing and compliance training and coding issues were directly impacting cash. They were seeking a meaningful long term solution to decrease waste and improve efficiency. Executive Leadership reviewed a variety of options to quickly and positively resolve operational issues and improve cash flow. They determined partnering with re|solution for a full insource with transparent pricing would best support these goals. Making a Smooth Transition DHCHD’s leadership and re|solution collaborated to create an Engagement Management Action Plan for an efficient insource transition. The plan outlined a variety of milestones and goals designed to optimize revenue cycle operations. DHCHD employees were transitioned to re|solution, retaining jobs in the community. Leroy Schaffner – CEO for DHCHD said, “re|solution’s focus on process improvement and best practices has improved and streamlined our billing and follow-up, while at the same time increasing our cash flow.” re|store™
  • 20. “re|solution started the project and quickly assessed our operation. Then they created a comprehensive management action plan to address the issues they found and drive improvements. Their monthly reporting package is great and we’re seeing data and analyses that we’ve never had access to before. They implemented their claims management technology which helped to increase cash collections for us. They also brought in other revenue cycle experts (coders, charge capture specialists, etc.) as needed to help train our staff. We’re very happy with re|solution and greatly value our partnership with them.” - Donny Pettit– CFO, Dallam Hartley Counties Hospital District Quickly deploying productivity initiatives and training creates a solid foundation for future performance While a typical outsource removes jobs from the community and does nothing to reduce expenditures, re|store™ insourcing eliminates these dilemmas. re|solution assumed responsibility for the day to day operations and immediately began work on implementing the Engagement Management Action Plan. An experienced re|solution revenue cycle manager was placed onsite to support training and mentoring the current staff and also took responsibility for managing the additional re|solution team brought on-site to assist in swiftly improving cash flow. Highlights of the best practice plan included:  Immediate compliance training/testing to staff  Reduce and stabilize DNFB  Resolve long standing coding issues  Conduct a charge capture review  Train ER registrars and clinic staff  Revise Self-pay letters and statements  Implementation of re|discover claims management technology Guaranteed Performance – Peace of Mind re|solution quickly provided additional staff upon transition to ensure revenue cycle improvements proceeded quickly. The business office staff immediately completed compliance and billing training and testing eliminating billing compliance exposure by utilizing best practices. Cash increased nearly 4% on flat revenue. re|solution collected additional cash and DHCHD realized a net benefit of nearly $500,000. DHCHD has requested that re|solution also assume responsibility for clinic billing operations due to superior performance. The engagement continues to focus on moving all key performance indicators even closer to best practice levels. For more information Visit us at www.ereso.com, or call us at 1.800.355.0410
  • 21. Overview The need An outstanding AR of $2,926,000, of which $1,179,000 was over 90 days and Gross Days in AR exceeding 117, Muenster Memorial needed help to reduce their AR. Another immediate need was to address Discharged Not Final Billed (DNFB) which had climbed to $735,000 or nearly 29 days of gross revenue. The Solution Muenster Memorial deployed re|cover™ complemented by an experienced re|solution manager to assist in assessing staff, providing training and re|solution tools left behind for ongoing improvement and success. The Benefit Muenster Memorial with processes implemented by re|solution’s experienced staff and use of proprietary tools reduced their AR over 90 days from $1,179,000 to $474,000 and DNFB decreased from 29 days of gross revenue to 5 days, an 83% reduction. The AR clean-up generated over $700,000 in cash collections while the DNFB reduction accelerated another $300,000 in cash for the hospital, and increase of over $1MM in an 18 bed facility Muenster Memorial Hospital achieves a significant reduction of Accounts Receivable and DNFB Assessment, training and a reduction in Accounts Receivable completed, increasing both staff confidence and performance. Muenster Memorial is an 18 bed, Critical Access Hospital located in Cooke County, Texas. Since 1964, MMH has served Muenster and surrounding communities with the same philosophy; the value of patient care depends on the outcomes achieved and resources used. MMH’s dedication to serve the community with integrity, compassion, public service, efficiency, and support create an atmosphere of trust, and open communication. The Muenster Hospital District’s staff and Board are driven by a vision to work with the community to provide total healthcare needs as well as to inform and educate to improve the wellness of the community. Ensuring Community Services Like many Critical Access healthcare providers today, MMH faced an immediate need to reduce $2,926,000 in Accounts Receivable of which $1,179,000 was over 90 days with Gross Days in AR exceeding 117. Addressing the Discharged Not Final Billed (DNFB) which had climbed to an unacceptable amount, nearly 29 days of gross revenue had become critical. MMH’s Board and leadership determined that to accomplish these goals they needed to improve organizational structure, identify staff deficits and implement a training program to address working procedures and standards while quickly reducing the AR and DNFB. They realized that changes were needed to ensure their continued success in Cooke County. Balancing Community and Revenue Cycle Integrity Needing immediate improvement, leadership partnered with re|solution to assess the situation, provide training and improve processes while augmenting MMH staff to reduce the nearly 3MM in outstanding AR and minimizing bad debt. Providing local staff with additional training kept jobs in the community while increasing employee skills and confidence. Lynn Heller – Former CEO for MMH said, “Our accounts receivable had grown to a level that was unmanageable by our staff. My options were to hire additional staff or bring in someone who knew what needed to be done, and had the expertise to get it done. The return on investment has been outstanding. A major benefit was to reduce the volume of accounts receivable accounts to a level that is manageable by our staff. Of course, collecting a bucket full of additional payments has been good too!” re|cover™
  • 22. “Our accounts receivable had grown to a level that was unmanageable by our staff. My options were to hire additional staff or bring in someone who knew what needed to be done, and had the expertise to get it done. The return on investment has been outstanding. A major benefit was to reduce the volume of accounts receivable accounts to a level that is manageable by our staff. Of course, collecting a bucket full of additional payments has been good too!” - Lynn Heller – Former CEO, Muenster Memorial Hospital A Solid Foundation through Training, Mentoring and Proprietary Tools is Key to Measureable Sustainable Results MMH leadership worked closely with re|solution focusing on each item identified to make the necessary improvements. An experienced re|solution project manager (RPM) was placed onsite to assist in training and mentoring the current MMH staff and also took responsibility for managing the additional re|solution team brought on-site to assist in the critical cash acceleration project. re|solution immediately began work on implementing improvements, providing the resources, skills, and processes necessary to quickly increase cash performance. The goal was to reduce accounts receivable as quickly as possible and to provide the guidance and tools necessary for MMH to measure staff productivity and create sustain improvements. re|solution provided a full scope of services during the cash acceleration:  Interviewing leadership and staff to determine deficits  Providing the resources, tools and training to increase staff knowledge, confidence and skills  Collecting on assigned accounts to quickly decrease aged accounts receivable  Reducing the DNFB for additional cash Guaranteed Performance – Peace of Mind Reduction of MMH’s AR over 90 days from $1,179,000 to $474,000 and DNFB decreased from 29 days of gross revenue to just 5 days, an 83% reduction, generating just over $1,000,000 in cash for the hospital. The improved performance indicators are impressive, but more significant are the process improvements and the knowledge transferred to Muenster Memorial’s business office staff. For more information Visit us at www.ereso.com, or call us at 1.800.355.0410