Achieving A/R Reduction for Nearly 90% Resolution
Sagility assists a healthcare client in resolving high-aged, complex A/R claims, resulting in significant reductions and successful cash collection through systematic problem-solving, deep domain knowledge, and smart, rigorous follow-ups.
About the Client
The client, a healthcare provider, faced a significant challenge: resolving high-aged claims worth $208 million accrued between November 2020 and March 2021.
High-Aged Claims Resolution
The client grappled with a complex set of accounts receivable (A/R) problems, rooted primarily in the difficulty of resolving high-aged claims, specifically those that were 180+ days from the Date Of Service. Given the value of these claims—amounting to $208 million—it was imperative to resolve them efficiently.
Expert Team Deployment
We assembled a team comprised exclusively of seasoned denial/AR experts who had proven their mettle in resolving high-aged claims. Each team member was a master in their field, having successfully navigated similar challenges in the past. Their proficiency and experience were instrumental in quickly understanding the intricacies of each claim and formulating an effective strategy for resolution.
Each claim was meticulously scrutinized and grouped based on several key factors, including priority-based action codes, payer groups, and denial reasons. This systematic stratification was essential for conducting an efficient and comprehensive root cause analysis, paving the way for targeted and effective resolutions.
Upstream Process Fixes
A significant chunk of the A/R, about 31% stuck in the 180+ day bracket, was found to have issues at the payer level. Sagility identified and addressed these promptly, which included provider credentialing problems such as contract termination or delayed start dates. These highlighted issues were escalated with the client’s stakeholders for immediate resolution, significantly reducing the A/R backlog.
SMART and Rigorous Follow-Up
We transformed the follow-up process, implementing a strategy that cut down the time between follow-ups by 50%. This SMART approach (Specific, Measurable, Achievable, Relevant, and Time-bound) facilitated quicker information collection, speeding up the process of identifying and addressing the root causes of denials.
Optimization of Process Hand-off Points
To ensure that each claim received the attention it needed from the right department, we introduced an effective triaging process. Depending on the specific requirements of each claim, it was sent to the appropriate department, be it coding, nurse auditors, payment posting or correction, clinical appeals, or the responsible payer group liaison.
Periodic Review and Course Correction
A critical part of our strategy was maintaining transparency with our client. We presented a weekly view to the client that showed the inflow of new inventory/claims, the outflow of resolved claims or those directed to the right department, the visibility of outstanding AR, and its collectability. This report acted as a mirror, reflecting the progress made and areas requiring course correction, ensuring our strategy was continually optimized to meet the challenges head-on.
On 180+ Day Claims
From All Claims