Customer Success Story

Convergent RCM Collects Aged receivables for faith-based healthcare system

The Challenge

A large non-profit health care system’s Florida business office made the decision to focus on newer insurance claim denials and slow pays, thus necessitating assistance for the swiftly increasing backlog of aged receivables.

Determined to maximize reimbursement and meet their internal collection goal, the health system pursued a partnership with Convergent Revenue Cycle Management (Convergent). With an aggressive attorney-centric approach to collecting on aged claims, Convergent brings legal and clinical authority to its clients, helping them resolve claims that are stalled or denied for various reasons.

The Solution

The health system turned over an initial placement of over $11.5M in insurance accounts, aged over 60 days from discharge. The book of business presents a myriad of issues including but not limited to hard denials, contractual underpayments, wrongful delays, and coding corrections. Upon receipt of placement, Convergent segmented the claims by payer, age, amounts in controversy (dollar tiers), and assigned scores using a proprietary scoring algorithm. For further efficiency, Convergent grouped the accounts by payer and issue (denial), in order to work in batches, utilizing account scoring to identify claims with a higher propensity to pay.

Drawing on its deep bench of healthcare attorneys, Convergent conducted research based on statutory parameters and contractual provisions, crafting tailored appeals, as needed. Within one week of placement, Convergent had activated every claim and had taken all necessary steps to position the claims towards payment and resolution. Follow up was robust, averaging 14-28 days, depending on the nature of the claims and amounts involved.

The Results

Convergent collected $6.1 million, equaling 54% of the initial $11.5M placement. However, Convergent resolved 635 of 638 accounts for $11.4 million, equaling 98% of placement resolution. Furthermore, Convergent has received three additional placements from the client; these claims are still being worked or have already been resolved, with an average of 40% in collections and 80% in resolution.

As Convergent works on aged accounts, the health system’s staff is now free to focus their time on current billing and newer collections, thus making them more effective and efficient at what they do.

“We provided Convergent with the book of business, and they got right to it. I’ve worked with other vendors and there is typically a lot of back and forth. Convergent did not need much time to get up and running.”  Regional Director of Patient Financial Services

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