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| JPS Health Network increases cash and improves revenue integrity with greater claim accuracy and faster resolution of denials |
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| Problem |
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With constant changes in payor rules and regulations and time-sensitive processes, providers are challenged to ensure that every patient claim is billed correctly, on time and is paid accurately. Managing claims and denials with technology can significantly improve processes and workflow to help achieve a better first-pass payment rate, reducing denials, which leads to greater cash flow.
John Peter Smith Health Network (JPS) knew they had an opportunity to improve cash flow by addressing systemic issues that were creating a breakdown in the processing of healthcare claims and causing denials to go unresolved. The claims processing approach they had in place demanded significant manual effort by staff, and their accounts receivable (A/R) performance was trailing industry benchmarks. Therefore, JPS began a search for a revenue cycle management provider that could drive more effective results. Specifically, they were seeking to not only improve financial performance and staff efficiency, but also, to find a more responsive partner to meet their needs. |
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| Solution |
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After a comprehensive evaluation process, JPS selected MedAssets, the #1 ranked solution provider in the KLAS market category of Claims Management. “We chose MedAssets because they have the most dynamic revenue cycle management system available,” said Dee Chaisson, vice president of finance for JPS Health Network. “They have produced a comprehensive and extremely scalable system that has proven to produce positive financial impacts on the billing cycle.”
JPS implemented MedAssets' Claims Management, Remittance Management and Denials Management solutions, as well as its automated secondary billing and Reports Management for ad-hoc reporting and trending. These integrated solutions helped JPS improve net collections by:
- Increasing billing accuracy and reducing denials through increased automation, editing and workflow
- Resolving billing issues, payor rejects and denials in a timely manner with improved workflow
- Driving accountability for errors and lost revenue across the health system
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| Results |
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Since implementation, JPS has experienced significant revenue cycle improvements on their third-party payor business for Commercial,BCBS, Managed Care, Medicaid and Medicare. JPS’ clean claims rate is currently at an all-time high of more than 90%. The improvement to the clean claims percentage rate has also significantly impacted JPS’ A/R days. Nine months after going live, JPS’ third-party A/R fell an average of 24 days reflecting a 27% reduction and a $9.5 million cash improvement. Commercial A/R alone fell an average of 90.4 days, a 44% reduction. |
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Improve your
Operating Margins
MedAssets improves
and sustains
operating margins
by 1.5% to 5%.
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Improved claims editing, first pass rate and payer first pass payment rate, resulting in improved cash flow and lower A/R days. |
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