How Knack Global recovered Hospital’s drastic fall in Revenue

How Knack Global recovered Hospital’s drastic fall in Revenue

Initiated with the sole aim of providing the processes of Enterprise IT, Business Analytics and Software Support Services, it was in 2007 when Knack made the decision to focus its energies on RCM healthcare services for hospitals, physician groups, and DME suppliers. Knack Global has extensive expertise providing RCM services to over 2,000 DME suppliers.

As a medical billing company, it is our responsibility to sustain/increase revenue and to accomplish our responsibilities we have a dedicated research and development team to keep an eye on reports every month such as:
  • Accounts Receivable Aging Report
  • Payment Trend and Collection Reports
  • KPI (Key Performance Indicators) Report
  • The Top Carrier/Insurance Analysis Report
  • Tracking Clearing House Rejections
  • Tracking payer reimbursement metrics
  • Tracking denials

Customer’s Profile

A Hospital licensed by the State of Illinois Department of Public Health.

They offer a full range of comprehensive acute inpatient, surgical and outpatient care including:

  • Trauma
  • Orthopedics
  • Molecular Medicine
  • Cardiopulmonary
  • Vascular
  • Oncology
  • Durable Medical Equipment

Business Situation

For healthcare providers optimizing the RCM process is a primary focus area and for streamlining the complex collection process and to overcome continual declines in reimbursements they hire us.

While researching billing against payment by collection’s report in January 2019 we found a decrease of 50.48% in revenue which is not a usual fall within a month and was compelled to excavate further to find the cause.

Technical Situation

After deep diving in payment/collection’s reports below mentioned were our findings :

  • Decrease in the average number of checks being received every month
  • Decrease in average payment being received via EFT every month
  • Increase in the aging of claims
We were constrained to call major payers contributing to a decrease in revenue (listed below) to find the cause.

Root Cause

Follow up with Insurance companies and communication with the hospital provided the reason for delay/decrease in revenue.

  • In November 2018 the Hospital switched their branches.
  • It was neither updated with 500+ insurance companies nor in the software.
  • Causing claims to go with the incorrect old address.
  • Resulting hold in releasing payments by a few Insurance companies like
    Medicare
    Blue Cross Blue Shield
    Medicaid
  • Few companies issued checks to the same incorrect old address.
  • Causing the return of checks back to Insurance companies.

Revenue was decreasing at the same rate until we infer the root cause and from 132.45% it came to 19.92% an unusual decrease of 112.53% in four months.

Solution

To update the provider’s address in the Insurance company’s records we need to have a W9 form with updated details.

  • We got in touch with Hospital to enlighten the root cause behind an enormous decrease in revenue and to get an updated W9 form.
  • The hospital provided their updated W9 form without any disruption.
  • We had them updated with Insurance companies.
  • Updating only W9 form with Insurance companies was not convincing.
  • It was only for those Insurance companies where payments were put on hold.
  • For the checks which were issued at the incorrect address, we were supposed to call them and to have the checks re-issued at the updated address.

This was not a task to be completed in a short interval of time but to expedite the process.

  • We ran a report of claims billed in recent months where denials are not posted either any payment.
  • We were advised by most of our major payers to fax the spreadsheet of claims with the required details to have the checks re-issued.
  • For a few payers, we aligned a separate team to call Insurance companies to have the checks re-issued.

Outcome

Revenue is what keeps your business alive. Beyond being a lifeline, revenue can give you key insights into your business.

Any time revenue decreases there is a significant time (months) needed to pull it up to normal stage due to the time taken by payers for processing and releasing checks.

It took a few months to get on hold payments and to have the checks re-issued.

The very next month we were proudly able to share our initial triumph with the Hospital and the rise in revenue which was unconventionally increased by 109.91%.

Finally, we succeeded in increasing the customer’s revenue and achieving the desired expectations.

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