Case Study: Disrupting Negative Revenue Cycle Trends
Managing cash flow efficiently is a top priority for hospitals, health systems, and large provider organizations—today perhaps more than ever before.
The need for better processes and procedures in the revenue cycle is paramount to improving the operational structure with a focus on cash-on-hand, DNFB, and accounts receivable.
Client: Level 1 Trauma Center
When Shearwater Health came aboard, one of the largest Level 1 trauma centers in the United States faced several common challenges:
- Staffing and retaining coders
- Untenable and rising DNFB
- Lack of a single-source solution for coding across all service lines that included a platform meeting stringent requirements
To determine how these challenges applied specifically to the client, Shearwater analyzed the client’s situation thoroughly to develop an action plan that would reduce DNFB; provide skilled and trained nurses for highly efficient, high-quality coding; and deliver a platform that tracked and managed the workflow.
Significant Coding and DNFB Opportunities
As is often the case with large provider groups, hospitals, and health systems, Shearwater Health’s client held significant DNFB. Reports of large systems that are facing DNFB of almost 18 AR days are not uncommon.
Proper management, procedures, and policies can correct inefficiencies and greatly reduce the number of days revenue sits in billing.
There are a variety of reasons for DNFB:
- Incomplete coding
- Coding that lacks information
- Coding that awaits changes, which is entered within the “suspense” period
- Codes that have been rejected during the claim-editing phase
Hospitals, health systems, and large provider organizations that face growing DNFB must identify the cause of the issues and build processes to mitigate their potentially devastating impact.
Solution: Coding Teams and Platforms
Shearwater implemented a series of solutions that disrupted the negative trend and shifted the control back to the client.
Shearwater Health brought in full-time trained, certified coding staff skilled in inpatient and outpatient coding to perform concurrent coding services. Shearwater Health’s coding teams are AHIMA and AAPC certified coders with one or more of the following credentials: CSS, CPC-I, CCS-P, CPC, CPC-H, COC, CIC, HCS-D, and CDI-P.
Further, Shearwater Health took over complete management burden of the coding team, ensuring quality control, staffing levels, career management and advancement, and ongoing training.
To optimally manage the workflow and enable concurrent coding under stringent requirements, Shearwater Health implemented its proprietary productivity tracking tool, TotalView.
DNFB Reduced by $80M+
Shearwater Health reduced DNFB by more than $80 million—to the lowest levels in over 10 years.
Another milestone: Achieving greater than 95 percent quality ratings for all lines of business in coding that included inpatient, outpatient (facility), and outpatient (professional) areas. In addition, Shearwater is now providing concurrent coding across all service lines for the client.
Are your coding and DNFB controlled? Contact Shearwater Health today: firstname.lastname@example.org or 615-921-9510.
You’ll be impressed by how we can help you.