Like tall buildings, large organizations require strong foundations. This is especially true during periods of rapid growth and acquisitions. In such hectic times it is essential to have strategies and plans in place to ensure that critical infrastructure — people, processes and technology — will meet the increasing demands of a larger, and more complex, organization. Failure to do so can not only interfere with future acquisitions, but also jeopardize the business, as critical systems break down under pressure.
Such was the case with a fast-growing healthcare organization, which had been notified by several of its acquired providers that revenue had fallen precipitously after they were acquired. The organization knew it had a problem with its revenue cycle, but could not identify the specific points of breakdown. In a bid to improve quickly, it retained Protiviti to assess revenue cycle operations.
Just two weeks into the six-week assignment, it was clear that the organization’s revenue cycle processes — developed for a much smaller company — were not scaling to the recent growth. Having seen enough evidence of this, the client cut short the assessment and moved directly into remediation, appointing Protiviti’s project lead to serve as interim vice president of revenue cycle with the objective to address all components necessary to support the growing business. One important aspect of that objective was upgrading the personnel assigned to operate and manage this critical business function.
It became apparent early in the assessment that the issues were deeper than perceived at first glance. Workarounds implemented as the company grew were not working at scale. From an initial focus on staffing and collections challenges, the scope of the engagement expanded to become truly transformational, eventually including all aspects of the revenue cycle infrastructure — from hiring and training to business processes and technology.
A comprehensive remediation plan requires working on the three fronts of people, processes and technology, often at the same time. Protiviti’s project lead, acting in the capacity of interim vice president of revenue cycle, filled critical vacancies with temporary resources using Protiviti’s Managed Business Services model, emphasizing a high level of experience in revenue cycle operations. To restore the cash flow quickly, we brought in a specialized team staffed with high-caliber resources to handle the billing integration of acquired entities, and initiated expert-led workstreams in specific problem areas, such as patient access, accounts receivable, reporting, refunds and credit balances, and compliance. Other priorities included the hiring and training of competent staff and working with both clinical and administrative departments to identify other revenue cycle shortfalls that had developed during the company’s intense acquisition period.
There were several immediate opportunities to improve the consistency of the cash flow, while other sustainable process improvements were under way. For example, past-due bills had previously been outsourced to a third party for collection; however, that vendor had no access to the patient systems, rendering the collections process inefficient and frustrating for patients. To improve both the collection process and patient satisfaction — a key goal of the organization — Protiviti built an in-house call center from the bottom up, staffed by personnel with revenue cycle experience and led by Protiviti experts.
Systems upgrades were required throughout the organization, beginning with the core patient management system, to address the needs of day-to-day operations and help secure sensitive data. At the time of engagement, core systems were unable to communicate with the systems of acquired providers. There was no consistent reporting, which made it difficult to track not only the revenue cycle, but all business processes, including credentialing and systems permissions.
As part of remediation, Protiviti created reporting dashboards and implemented visual analytics to accelerate transaction processing and improve monitoring and tracking across the board. New credentialing software and other improvements were needed to create a centralized database of all provider information and more rapidly distribute provider enrollment applications. The new credentialing software reduced application time, from a week or more to a 2-hour process. This significantly sped up payments from insurance companies to those providers — a key performance metric for this project.
On the compliance front, the company adopted several measures to reinforce HIPAA compliance — from implementing a comprehensive education and awareness program the Protiviti team developed, to improving patient privacy through email encryption, document destruction, removing all personnel with no connection to the revenue cycle from areas with access to patient information systems, and installing locking doors to control access to patient areas.
Finally, Protiviti worked with the compliance committee to review Medicare and Medicaid reimbursement requirements and develop internal rules and guidelines. Education was critical — including training on HIPAA and who should and shouldn’t have access to patient information.
Eager to resume its aggressive growth, the company established a 90-day deadline for the onboarding of recent acquisitions into the billing department, and nine months to complete the entire revenue cycle remediation.
With these aggressive deadlines in place, the company set a strong tone at the top, with the CEO, CFO, CMO, compliance officers and regional vice presidents all participating in the revenue cycle steering committee. This strong executive support, along with the decision to stabilize the situation by appointing a Protiviti expert as an interim VP of revenue cycle, cleared the way for us to overhaul acquisition onboarding 30 days ahead of schedule, and the entire engagement in only four months.
Through a combination of the right talent, vision, processes, reporting and technology, this healthcare leader was able to resume its rapid expansion ahead of schedule. Provider insurance claim rejections decreased from 11 percent to 5 percent. Outstanding accounts receivable decreased by approximately 9 percent. New compliance procedures lowered the risk of regulatory audit and sanction. Most important, a revenue cycle structure was set in place, complete with experienced people and the right technology and processes, to support the growth objectives of the organization.
One commonality in all successful engagements is the extent to which senior management embraces and commits to the project goals and objectives.
In this case, management embedded Protiviti in day-to-day operations, going so far as to appoint a Protiviti expert as interim vice president of revenue cycle and delegate hiring authority to her. This level of trust and cooperation had a significant positive effect on the outcomes achieved.
Another important success factor was the ability of the Protiviti group to tap into the highly qualified resources of its partner, Robert Half. Several of the senior staff Protiviti provided during the remediation phase of the project were hired by the company — a testimony to the client’s commitment to sustained quality.
Many fast-growing companies become so focused on moving forward that they neglect the infrastructure and resources required to sustain that forward momentum. By briefly pressing pause on its growth and taking the time to implement the necessary improvements across people, processes and technology, this healthcare organization was able to resume its upward growth trajectory quickly.