Revenue Cycle Improvements, Business Process Reengineering, Central Business Office Development

The Client

One of the largest practice management organizations in the United States, the company operates an array of health care clinics and independent practices. This client faced a growing accounts receivable backlog, and significant operational, organizational, and technological challenges throughout its business function. The organization needed to quickly evaluate and streamline its internal processes to improve efficiencies and revenue flow.

The Challenge

After several business acquisitions, each with its own business processes and technologies, the client's financial operations were disconnected-technically and organizationally. Its legacy billing process included ten labor-intensive steps-each requiring manual data entry and use of a range of insurer codes and service pricing-to secure payment for the clinic and/or physician. An incorrect data entry resulted in the rejection of-or major delays in receiving-payments to all parties, including patients.

The client needed to manage its existing systems, determine and implement improvements in technology and business processes, and address a myriad of personnel issues-and then create a streamlined central business office (CBO) capability.

The Solution

The BearingPoint team's exhaustive review of the company's billing process uncovered an array of critical gaps and inefficiencies. Our assessment revealed the client was significantly hampered by high turnover of personnel, inefficient business processes, an overall lack of coordination, and an insufficient technology infrastructure that resulted in a growing backlog of accounts receivable, which critically impacted revenue stream, cash flow, and bottom-line profitability.

The BearingPoint team developed a detailed blueprint for efficiency, which focused on two key areas for redesign and reorganization: the client's front-end financial operations and its central billing office.

For the front-end redesign we:

• Identified areas for improvement in training, processes, and guidelines through a comprehensive series of one-on-one interviews and workshops with client staff and executives
• Developed policies and procedures to improve the front-end elements of the revenue cycle
• Provided customized training for performance management-related job aids and support tools

In reorganizing the company's CBO we:

• Established a new structure to support best-practice operational functions
• Retrained client staff to deliver newly developed, standardized policies and procedures for billing, collection, and customer service

The Benefits

As a result of the project, the client realized significant improvements in employee morale, cash flow, and error elimination throughout the revenue cycle. Specific improvements included:

• Gross days in receivables reduced by 15 days
• Cash collections as a percentage of gross revenue increased from 56.5 percent to 61.8 percent, improving cash flow by $2.5 million
• Denial rate reduced from more than 50 percent to less than 10 percent through improved claims content accuracy
• Improved customer service through reduced hold-times, reduced computer downtime, and caller-abandon rates
• More than 90 percent of incoming calls resolved by customer service representatives
• Reduction of annual timely filing/authorization write-offs by over $1 million
• Self-pay cash collections $1 million over goal
• Increased physician confidence in the client

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