Issue link: https://beckershealthcare.uberflip.com/i/731691
140 Executive Briefing of process improvements that could be communicated to CoxHealth and imple- mented on an ongoing basis throughout the project. For example, Xtend identified a primary payer code issue with CoxHealth's Med- icaid secondary billing. Because these bills were leaving the health system with an incorrect identifier, Medicaid was automatically rejecting them, requiring CoxHealth's billing staff to perform man- ual data entry and resubmit the claims. After Xtend identified the root cause and corrected the coding, the time required by CoxHealth to correctly submit each claim fell from 10 minutes to one minute. And since this improvement resolved a backlog of more than 2,100 accounts awaiting manual intervention, the time savings was so significant that CoxHealth was able to reallocate one FTE to focus on other priority areas. Similarly, Xtend also identified and helped CoxHealth correct other billing issues that were causing claim denials — such as claims that failed to include the primary indicator of commercial in- surance from problems with present on admission indicators on inpatient rehab claims, to missing healthcare common procedure coding system codes on lab charges that Medicaid requires, ICD-10 coding errors and VA claims submitted without medical records. Meanwhile, Xtend also identified issues with precerti- fications that had resulted in lost revenue opportunities, identified more efficient processes for billing qualified Medicare benificiary accounts, and updated the CDM to report correct codes for Medic- aid processing. To help cement process improvements for the long term, Xtend also provided a num- ber of onsite training sessions, lasting two to three days each, for CoxHealth's billing staff. "They focused on some specific ar- eas and skillsets in billing and collections," says Mr. Strong. "And since the root cause analyses had identified certain areas for improvement, they could tailor the train- ing to what they were actually seeing in our billing staff's work. The training was a big area where we got value." Making a Bottom-Line Impact After approximately 10 months, the re- sults to-date have been impressive. All in all, Xtend collected $37.8 million, resolving 99 percent of the total reve- nue represented by the aged receivables CoxHealth had assigned to it. In particular, the Xtend team reduced the volume of inventory older than 360 days by $11.3 million, while resolving an addi- tional $5 million in receivables between 180 to 360 days. At the start of the engagement, accounts older than 90 days represented 39 percent of CoxHealth's third-party inventory and 24 percent of its dollars. These metrics have improved significantly. Currently, accounts over 90 days represent 16 percent of the in- ventory, and dollars more than 90 days are at 15 percent of the total. "We have seen an increase in cash and re- duction in bad debt that helped us solidify our year-end close," says Mr. Strong. "We significantly reduced our A/R and are mov- ing toward peak performance indicators." Meanwhile, based on these improve- ments, CoxHealth extended Xtend's in- volvement to include a new, 12-month project focused on smaller balances. There, too, the work is paying dividends that go beyond the actual accounts the Xtend team has worked. As an example, Mr. Eley notes, staff at the Nashville ser- vice center recently discovered that the Medicaid accounts they were handling contained an inaccurate code descriptor that was causing payments to be delayed. The issue "was creating the need for a sig- nificant amount of manual rework" by the billing staff, Mr. Eley says, "and it involved a pretty sizable amount of volume and manpower. Now we've been able to solve this problem with automation." The fix is so recent that Xtend and Cox- Health have not yet been able fully to measure its impact on the health system's revenue cycle. But they suspect it will be significant. "What we found," Mr. Eley says, "involves only one payer — Medic- aid. This could spill over into Medicare accounts, which we do not work [for this client]. I would imagine the correction will create a systemic improvement." n "After approximately 10 months, the results to-date have been impressive. We have seen an increase in cash and reduction in bad debt that helped us solidify our year- end close. We significantly reduced our A/R and are mov- ing toward peak performance indicators." — David Strong, System VP of Hospital Revenue for CoxHealth Sponsored by: Xtend Healthcare, A Navient Company is one of the fastest growing revenue cycle solution companies in the industry, offering 100 percent onshore solutions. Our senior management team has more than three decades of dedicated hospital revenue cycle experience with hundreds of hospitals and hospital systems in 48 states. Xtend Healthcare clients range from large teaching hospitals and urban medical centers to rural critical access hospitals. We have experience working with large nonprofit and religious affiliated hospital systems as well as some of the largest for-profit healthcare systems. Xtend Healthcare offers cutting-edge technology, experienced staff, and 100 percent customer satisfaction. For more information, please contact Tammy Caballero, Executive Vice President of Revenue Cycle at 1-800-882-1325 or by email at TCaballero@xtendhealthcare.net