Midwestern Nonprofit Health Network
Staffing challenges led to an increase in accounts receivable – TSI Healthcare implemented a high-balance aged insurance follow-up program to help get revenue back on track.
Due to a number of back office and staffing challenges, a Midwestern Health system was struggling with extremely high account-to- representative ratios. This left them with an excess backlog of high-balance accounts that were often going unworked and growing less collectable with every passing day. Over the course of 2018 and 2019, the Health System’s revenue cycle challenges grew and were beginning to have a very immediate and negative impact on their ability to serve their patients.
Naturally, in order to overcome these challenges the Health System doubled-down on their efforts to hire more revenue cycle representatives, believing this to be a matter of overcoming growing account volumes with increased headcount. But this hiring push proved more difficult than originally imagined – the process of recruiting, vetting, hiring, onboarding, and training new representatives ultimately proved extremely costly. But they soldiered on.
That is, until COVID-19 hit in early 2020 and ground the Health System’s recruiting initiative to an abrupt halt.
Left with a swelling volume of accounts, increased aging, and the inability to adequately staff their receivables teams, the Health System looked outward for assistance. With a preexisting set of revenue cycle management and collection vendors who did not achieve desired outcomes, they went to TSI Healthcare (formerly Convergent Revenue Cycle Management) looking for solutions.
In June 2020, the Health System made the decision to engage TSI Healthcare in a one-time placement of their surplus high- balance accounts. TSI Healthcare and the Health System partnered to resolve and collect on high-balance claims that were 60 days or older. In order to deal with the nature of the challenges that came with this sort of inventory, TSI Healthcare implemented a high-balance, aged AR insurance follow-up program for them. TSI Healthcare was able to step in and make an immediate impact with an expedited onboarding phase and eye on getting accounts placed and worked as soon as possible.
TSI Healthcare provided the Health System with dedicated points of contact in addition to the enhanced team approach utilized to tackle placement influxes with they needed additional assistance. Moreover, TSI Healthcare would send high value and complex cases to their dedicated legal team, provided coding and billing assistance via specialists in both disciplines, and staffed Medicare specialists on the team.
But what started out as straightforward relief from excess AR inventory quickly developed into a more strategic, long-term relationship.
After TSI Healthcare helped the Health System with their initial clean up their revenue cycle with a gross resolution rate of 79%, they continued their partnership together with ongoing monthly placements. Not only that, they both have partnered on a number of special projects requiring TSI Healthcare’s consulting. TSI Healthcare’s UR Nurse Staff would review special audit cases and provide written determination on next steps for the Health System, as well as make recommendations for OBS billing where warranted.
TSI Healthcare has also delivered issue/trend spotting analysis, acceleration of payment of groups of accounts, accounting/adjustment and balance reconciliation in their system of record. TSI Healthcare identifies accounts that are paid correctly but still show large balances. This may be due to incorrect use of CARC codes that tend to increase the AR balance. These balances are carefully investigated and TSI Healthcare advises the Healthcare System on adjustments needed to reduce aging and AR balance.
Today, the average age of placements is between 90-180 days old. As of the end of May 2022, more than $150M in insurance receivables has been placed with TSI Healthcare. To date, TSI Healthcare has collected over $22M for the Health System. Having recalled roughly $45M worth of placements, about $52M was adjusted – leaving nearly $25M in active inventory. Utilizing global scale, industry leading analytics and technology, a stable of healthcare revenue cycle management experts, and a commitment to compliance and data security, TSI Healthcare has achieved a net recovery rate of 43% for the Health System.
The Results
79%
Gross resolution rate
$22M
Collected in two years
43%
Net collection rate
TSI Healthcare Revenue Cycle Solutions
- Complex Claims and Denial Management
- Third-Party Follow-Up
- A/R Analysis Recovery
- Zero-Balance Audit & Recovery
- Backoffice Functions
- Patient Access Solutions
- Patient Balance Collections
- Statements and Billing
- Customer Service Overflow
- Accounts Receivable & Payment Plan Acquisition
