Veteran's Administration Program Case Study

Convergent Increases VA Cash for a large tennessee health system

The Challenge

A large, non-profit Tennessee health system made the decision to begin focusing on payers outside of the Veterans Administration (VA), due to low recoveries, complexity and time-consuming nature of said claims. Determined to maximize reimbursement and meet their internal collection goal, they extended their existing partnership with Convergent Revenue Cycle Management (Convergent) to fully manage their VA Claims.

Convergent was assigned an initial clean up placement of over $14M, with some claims being almost 365 days old. The book of business presented a myriad of issues including, but not limited to, timely filing and coding denials, lack of documentation and authorization, EDI re-route issues, and denial of bill type 851 claims. With an aggressive attorney-centric approach to collecting on VA claims, Convergent was able to bring legal and clinical authority to the health system, helping them send a clean bill and resolve stalled or denied claims.

The Solution

Convergent worked closely with the local VA Station to check Veteran eligibility, other health insurance (OHI) listed, and verify authorization numbers of all claims in the initial placement. Our team of attorneys then worked to obtain necessary authorizations, readjust claims placed with improper stations, resubmit corrected claims, and follow up on escalated claims. In collaboration with the local Director of VA & Community Affairs and PFS Commercial Supervisor, a standing bi-weekly call was scheduled to discuss problem claims, stay ahead of industry changes, and ensure that claims are submitted to the correct payer the first time. An action plan was developed by Convergent that would result in faster receipt of payment, noting re-occurring issues and opportunities for improvement that frequently decreased denials. Understanding these issues/opportunities lead Convergent to make changes in EPIC and internal workflows, minimizing coding and/or registration errors. Based on results and recommendations crafted from the action plan, with Convergent’s assistance, the health system became one of the first Tennessee facilities to start billing the VA electronically, shortening the claim resolution window.

The Results

Prior to Convergent’s onboarding, 0% of VA claims were paid within 30 days of service date; after Convergent streamlined the VA claim processing, 25% of VA claims are now being paid within 30 days. In addition, Convergent was able to improve collections, as it relates to VA claims, by 119%, increasing the health system’s VA collection average from $163k/month to$357k/month.

“Convergent brings a highly skilled and professional team to quickly integrate as a partner and drive excellent results. They are always available and ready to solve any obstacles we need to overcome.”

AVP Revenue Cycle
Non-Profit TN Health System

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