A nationally recognized integrated healthcare system engaged AGS Health initially to resolve a sizeable A/R backlog. The scope was later expanded to include specialized coding and additional billing support.
The health system provides care in more than 90 specialties and subspecialties and treats approximately 1 million patients from around the world each year. It leads the nation in cancer care, cardiology, neurosciences, liver and heart transplants, and pediatrics, and is consistently named both the top hospital and top children’s hospital in its state by U.S. News & World Report.
Challenge
- Rapidly growing aged, uncollected, and/or ongoing facility and professional A/R volumes led to a sizable backlog of small-balance billings.
- The health system’s existing vendor was not performing at expected levels or meeting key performance indicators (KPIs).
- The nationwide shortage of qualified revenue cycle professionals directly impacted its ability to maintain sufficient internal resources to keep pace with growing claims and billing volumes.
- The health system’s expansion led to higher billing volumes which, when coupled with the nationwide staffing shortage, contributed to a significant increase in operational costs.
Solution
Higher volumes due to rapid growth coupled with staffing challenges and rising operational costs forced the health system’s A/R team to focus its limited resources on processing higher-value claims and billings, amassing a sizeable backlog of small-value (<$1,000) invoices in the process. Existing vendors could not meet and maintain expected KPIs and service level agreements (SLAs). AGS Health quickly deployed a team of more than 80 highly qualified and experienced A/R professionals to clear the facility and professional backlogs and support the internal team with current A/R invoices. AGS Health’s high productivity and quality led the health system to expand the relationship to include additional A/R inventory, as well as HIM/ coding functions and billing edits. AGS continues to deliver high quality and exceed productivity levels and other KPIs across all functions and scopes.
- Eliminated an A/R backlog of more than 150,000 facility and 130,000 professional small-balance invoices within the first 12 months..
- Netted the health system more than $39 million in payments across both facility and professional A/R it otherwise would have left on the table or aged to write off.
- Achieved an accuracy rate of more than 95% and productivity levels of between 105% and 110%.
Small Balances = Big Revenues
Process Improvements
Data-Driven Collaboration
“By handing our backlog of lower-value invoices over to the experts at AGS Health for clearing, our internal team was freed up to focus on more impactful billings. AGS continues to deliver on quality, efficiency, and productivity, allowing us to recoup monies that would otherwise have been left on the table and keep our A/R current.”
