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A healthcare facility built to address unique demographic needs
with equally unique challenges presented to its Revenue Cycle.
Client Profile:
A new west-coast based greenfield facility, built to address the health equity issues in Compton, CA.
Patients served are from a diverse background of ethnicities, including undocumented aliens.
Revenue Cycle
Case Study Challenge:
The facility created unique challenges, as it was highly diverse in its patience, including undocumented aliens. As a result, it proved difficult to recruit to the area for key management and supervisor roles requiring diversity in the workforce.
A need to establish a revenue cycle operation and build all revenue cycle systems existed, with an additional need to develop a population health portal for patient navigation, education, telemedicine consultation, and medication management.
After recognizing a need for an experienced revenue cycle leader that had previously and successfully established other greenfield operations, this client turned to Nio.
The objectives required were the following:
- Manage the operations of the Revenue Cycle Department
- SME and build responsibility for Revenue Cycle systems and tools
- Implement best practices throughout revenue cycle
- Assist with the county and state reimbursement and reporting model
Action
Nio was established as a Vice President, Revenue Cycle Leader for the full operation and got to work. She selected and created a revenue cycle team including current management and staff, and recruited and procured the following staff:
-PA Director
-HIM Director/Case Manager
-Physician Revenue Cycle Director
-HIS Technical Analysts
-Admitting “Patient Advisor”
Additionally, Revenue Cycle best practice were implemented and baselines, graduating benchmarks, monitoring tools, trend reports, and management reporting for managers and executives were developed.
A population health network and patient access model was created, as well as the implementation of technology and deployment into the community.
Finally, Nio established herself as a LA County Reimbursement and Service Excellence Committee member, representing the facility at the county and state level for supplemental payments.
Result
- Revenue Cycle departments passed all governmental payer, state, county, JACHO, accreditation and certification under Nio’s leadership
- 103% of Net Revenue Collection
- Clean claim and payer acceptance rate of 90% within 35 days of first bill drop
- 3% above projection net reimbursement post 120 of active billing
- Percent of receivables greater than 90 was less than 18%
- DRG coding accuracy of 98% (ICD-9), ICD-10 tracking at 96%
- Population Health program received an innovation award and increased market penetration by 9%