Conway Medical Center in Conway, S.C., faced a number of emergency department (ED) billing challenges related to contract payment rate challenges, credentialing, delayed or lost payments, payers bundling or rejecting part of the professional services claim (such as EKG interpretation), and more. Accounts receivable (A/R) increased, both from difficulties with payer contracts and with claim line adjudication. The medical center also had trouble identifying outstanding balances between the facility and physicians/other professionals, which made the status of A/R unclear. In some instances, bills were mailed six to seven months after patient discharge due to payer disputes over professional CPT codes, causing a public relations issue for the medical center. Just as bad, physicians lost trust in the numbers the medical center shared with them. Conway worked with an ED revenue cycle specialist to:

  • Implement a separate process for physician billing
  • Renegotiate physician service contracts with payers
  • Improve physician and provider documentation processes
  • Increase collections by speeding up the billing process and through rigorous A/R management

Collections increased by 41 percent, or $9 million, and patient and physician satisfaction improved. During an early riser session Wednesday at ANI: The HFMA National Institute, presenters offered the following lessons learned that could help other organizations facing similar challenges:

  • If ED professional fee billing is underperforming and you are unable to obtain adequate resources and tools to manage this A/R separately from the facility side, segregating this function and outsourcing should be considered. Conway increased its collections through this approach, largely through improved documentation and its improved ability to work small-balance accounts
  • Vendor selection should include consideration of the vendor’s expertise in this specific type of billing and coding, availability of robust financial and other reporting capabilities for this specific service line, and the process and benchmarks that can be reported on a routine basis.

Publication Date: Wednesday, June 19, 2013