Below you’ll find short descriptions of just some of our projects, and their quantitative and qualitative success. If you’re a physician practice, take special note of the projects on a gray background.
Redesigned DRG Appeals Process Nets Additional $1.4 Million in its First Year
This organization’s appeals process for downgraded DRGs was broken. Lengthy and inefficient, it resulted in a high volume of appealable claims missing appeal deadlines and denied for being time barred. Although the organization had a 95% success rate for cases they did appeal on time, over 85% of their potential appeals were time barred.
We fixed their DRG appeals process, redesigning inter-departmental workflows so they could respond more quickly to payer DRG downgrade notices. Our process redesign reduced their time-barred DRG appeal denials rate to 15% – and brought in an additional $1.4 million in recovered cash during the first year following the transformation.
Provided Road-Map to Financial Stability for a Clinical Department
In this instance, a clinical department was struggling with high denials, reduced cash inflow, and above-average aging A/R that kept them in a financially precarious position. Hospital leadership had already taken a number of concrete steps to improve this department’s financial health. When none of these initiatives was successful, hospital leadership engaged RGC Group to bring a new perspective to their challenges and opportunities.
Leading an intensive collaboration with department administration and staff, RGC Group provided them with a detailed gap analysis and specific, actionable recommend-ations that linked directly back to the gaps identified. Department administration agreed that the RGC gap analysis and recommend-ations report offered them a clear path forward from current operational challenges toward reaching their revenue goals.
Built a 340B Compliance Audit and Scorecard Process to Protect Drug Costs
We built a process involving numerous departments for a multi-hospital system that empowers it to be pro-active about adhering to the intricate web of 340B legal compliance requirements. The audit process, worksheets, and scorecard we devised for this healthcare organization allow it to maintain the cost savings of their 340B program and will allow them to pass internal and OMIG audits in the future.
Implemented Chargemaster Management Technology and Workflows for Multi-Facility Hospital System
We implemented a chargemaster management tool at a major, multi-facility health system as part of their CDM consolidation project and ongoing chargemaster maintenance. We managed the technical implementation of the chargemaster toolkit, as well as the development and roll out of the revised business processes and training. The adoption of the new tool allowed the health system to finish their long-standing chargemaster consolidation project. Using the new tool, the department of charge capture now maintains only one, consolidated CDM, with changes cascading to individual facility chargemasters according to pre-set rules. As a result, chargemaster maintenance is simpler and more accurate, with cross-checks of facility CDMs against the corporate standard done on a regular basis to ensure accuracy.
Our firm was also engaged to provide configuration and training on an online, self-management tool that gives clinical staff across the health system direct access to their current chargemaster. They can quickly request a change, significantly reducing the time between the provision of a new set of services and the organization’s ability to bill for those services. Clinic administration also uses the online portal as a management tool for outpatient services, allowing them to monitor utilization goals and trends.
Negotiated Over $1 Million in Savings on a Managed Care Contract Modeling Product
A health system CBO selected us to negotiate and implement a managed care contract modeling product for them. As a result of our negotiation leadership, we saved the organization $850,000 on the cost of the product, and saved them another $230,000 in on-going costs over the course of the contract.
Reduced Charge Failures By Improving the Testing Process for Charge-Interfacing Systems
We helped this healthcare organization revise their testing process for the implementation of charge interfaces from EHR and point-of-care systems into the patient accounting system. We designed a stringent testing and approval method that significantly reduces the number of charging issues that occur when a new system is brought live. Through RGC Group leadership, the organization’s IT and PMO departments have become better prepared to conduct charge testing successfully.
The result is an improved ROI on each newly implemented system, with appreciably shortened time needed to do charge interface testing, and significantly reduced post-implementation work by patient accounts staff.
Projected 438% ROI for Institutional and Professional Managed Care Department
We started this project for a health-system MC department by helping them select a contract modeling and maintenance tool. We continue to work with them to expand the product’s implementation. The expected return due to improved knowledge of payer performance is projected to be in the millions of dollars over the first five years of use.
Implemented an Outsourced Billing Solution for Network of Dental Clinics; On-Track to Increase Revenue by $1.2 Million in the First Year of Operations
This network of five dental and oral surgery clinics spread out across multiple hospitals was having challenges dropping claims, managing appeals, and collecting its A/R. The hospital system contracted with a billing outsourcer and hired RGC Group to manage the transition.We facilitated discussion among clinic leadership and the outsourcers, and then we designed the business processes that would allow the outsourcer to successfully manage prior authorizations, billing, and denials. Some other deliverables on this project included developing customized training for clinic staff, and designing and validating revenue cycle reporting.
Revamped Revenue Cycle Reporting System that Put Users In Front of Data Most Meaningful to Them
For this project we helped an revenue reporting department revamp its reporting. We held focus groups with hospital leadership and practice units to identify what data they wanted and how it was most useful for them to receive it.
At the end of this project, c-level leadership had a new online reporting resource that empowered them to benchmark standards, and identify problems and their sources by practice area. Using the new reporting tool, they can now easily view critical information, such as denial reports, charge lag, expected revenue, visit closure rates, and write-offs.
Led Revenue Cycle Transition of a Hospital with $700 Million in Annual Revenue into a New Hospital System
In this project, a 500-bed hospital was sold. The transition services agreement between the buyer and seller (two health systems) called for the divesting system to retain some financial management for a period of time. We led the successful transition of revenue cycle systems, such as billing and patient registration.
Our staff planned the implementation with key revenue cycle leadership of the hospital and both health systems to ensure that the transition of the receivable and patient accounts information was seamless, on-time, and on-budget. With our assistance, the cost of the transition itself came in $1.5 million under budget.
Protected Up to 10% of an OB Department’s Medicaid Revenue by Updating Workflows to Comply with New Legal Requirements
As much as 10% of an OB department’s Medicaid collections were at risk if it couldn’t get compliant with new state Medicaid regulations within 3 months.
To get them compliant – and quickly – we created new clinical documentation requirements and business processes, as well as a technical solution for compliance. We focused on partnering across the organization (patient accounts, IT, HIM, and medical leadership) to build an effective solution that minimized disruption to current practice while complying with the new regulations.