Case Studies - Healthcare

COMPANY CHALLENGE

With Reimbursement Rates declining, and Operational and Capital expenses skyrocketing, a major New York City Hospital needed to prevent dollars from leaking from their Revenue Cycle. Error rates, undercharges and other internally sourced inaccuracies resulted in reduced reimbursement or no reimbursement at all. In addition, ever-increasing complexities associated with submitting and collecting billings, ongoing changes to billing and coding, and recruiting, training and retaining staff continued to exacerbate this problem. Increasingly, the Hospital executives came to realize the benefits of managing outcomes instead of staff, expenses, resources, processes and procedures.

OUR SOLUTION

During Phase I, Knowledge Solutions conducted a high-level operational baseline of existing policies, processes, systems and analytics across the revenue cycle to determine the impact on the overall information management strategy. In the initial phase, KS established a roadmap and laid the foundation for the Hospital to achieve its long term goals while providing immediate value by enhancing the current reporting and analytic environment. Phase II included the development of the company’s Revenue Cycle Management (RCM) Data Mart that includes a claims workflow manager, a custom analytic tool and an executive management scorecard.

VALUE/BENEFITS DELIVERED

KS Business Process Management Consultants collaborated with the Client to ensure that their organization’s business processes positively impact critical business drivers. KS achieved its goal of reducing the overall complexity of the Hospital’s information technology and made a positive contribution to their bottom line. KS RCM Solutions for this customer resulted in the following impacts to their business: