Strategies for a High-Performance Revenue Cycle

High-performing Touchette Regional Hospital in East St. Louis, Ill., serves a high self-pay and Medicaid population.

Touchette realized that many patients were arriving at the hospital for care who were eligible for Medicaid, but not enrolled. Further, Touchette recognized that some self-pay patients were providing incorrect home addresses, leading to potentially impaired collections.

Recognizing that these issues were causing undue financial hardships to the organization and, in some cases, its patients, leadership elected to invest scarce capital resources on state-of-the-art address verification and Medicaid eligibility software. The investments have greatly enhanced the accuracy of patient data, which ultimately are supporting collection, minimizing delay or return of medical insurance billing documents, and improving accuracy of bad debt and charity care reporting.

To recoup its monthly eligibility system fees, Touchette only needs to obtain coverage fewer than three times per month. Since implementing the new eligibility system, the organization has found that almost daily, a patient presents without insurance information and the system determines that, at the time of registration, the patient in fact does have valid coverage.

In addition, Touchette's system often finds that patients who have presented with insurance cards have either transitioned into or out of a Medicaid HMO product. Although this finding does not add to reimbursement, it does help reduce the revenue cycle time by enabling Touchette to bill the appropriate payer the first time.

With these achievements, Touchette's Medicaid payer mix has increased by approximately 3 percent-a result that can be attributed to the eligibility system-while its self-pay volume has held steady at a time when other facilities have seen increases.

Publication Date: Thursday, November 05, 2009