“Improved claim status It will provide more information directly extracted from the payer’s site that will not obtain in a regular claim state. “
—Jake Reid, senior director of Commercial Offices of the Income Cycle at St. Luke’s Health System
Challenge
The St. Luke health system is the largest health provider in Idaho, which manages around three million outpatient visits per year and processes more than 450,000 claims per month. As the organization grew, the volumes of ascent patients exert pressure on the personnel to maintain the billing processes working without problems. They needed a scalable solution to administer the monitoring of claims without increasing the personnel account or compromising patient care.
“We had a growing population and an increase in accounts receivable (AR),” says Jake Reid, senior director of commercial offices of the Income Cycle at St. Luke’s. “We could not keep up. To continue fulfilling our mission of supporting our communities and staying financially, we needed a more efficient way to raise income.”
They focused on four key questions:
- How can we maximize the efficiency of the personnel improving the follow -up after the claim?
- How can we take advantage of technology to handle the volumes of growing accounts without increasing staff?
- How can we avoid wasted touches so that personnel can focus on accounts that require follow -up?
- How can we accelerate the recovery of AR to improve cash flow and reduce aging?
Solution
After exploring internal and subcontracted options, St. Luke’s decided to implement Healths Experian Improved claim status To authorize and optimize the claims monitoring process. The tool extracts the award data directly from the paying sites and offers detailed claim states within EPIC, eliminating the need for the personnel to carry out claims to monitor the craft through the portals of the payers or the waiting of the remittances.
What began as a pilot with a single payer expanded rapidly to include other high -impact payers. The team liked how the improved claims status provided real -time information about denied, rejected and pending claims, so they can prioritize and Solve problems before. The claims are automatically engaged in the basic work tails in personalized rules, accelerating the monitoring of one to two weeks. This allowed the staff to concentrate on the right accounts and a reduced unnecessary work.
Reid says: “Improved claim status It will provide more information directly extracted from the payer’s site that will not obtain in a regular claim state. “The team values these richest data, includes improved data as proprietary ratio codes and processable explanations for each claim. No claim could establish their own rules of rules, reference intervals and cut -off points, and the claim codes were classified to determine the most appropriate work tail, the responsible for the lens of Owry. A consistent form, so the personnel can continue with the operation of the work effective Payers are added.
Read the blog: 6 steps to improve the claims award process
Result
The change to the state controls of automated claims significantly reduced the administrative load, achieving the following financial results:
- The denials fell by 76%, falling from 27% to 6.5% since 2017
- The accounts “disarmed/not invoiced” were reduced by $ 15 million per month
- The billing of the aged hospital for 90 days now constantly meets the Silver or gold points of Epic, with the surveillance list of a greed from $ 13 million to less than $ 1 million since it was headed in 2019
- The patient’s billing for 90 days is now in only 4.5%, placing St. Luke among the best epic users
Automation also helped St. Luke’s save the equivalent of three full -time employees every year. With less unqualified accounts and more efficient workflows, the general cost of charging was reduced. The staff appreciated having better data and more time to concentrate on complex accounts, which increased their ability to support patients directly.
Reid says that with Improved claim statusThe organization has successfully achieved its objective of accelerating the resolution and denial management of AR, without overloading the staff. He attributes this to continuous tests, improvement and close collaboration with Experian Health:
“Much of our success came from the customization of construction to our workflows and processes. It will lose the impulse and purchase of the staff if it does not ensure that the construction is solid. The importance of the tests cannot be underestimated. Finally, and in the experience of Experian it has always been very receptive to my teams and I hope that is the same for you.”
Discover more About how the improved claim state accelerates claims monitoring and improves cash flow.
