Gaining $100 Million in Incremental Revenue in One Year

The Challenge

A hospital client struggled to manage the revenue cycle due to staffing turnover, lack of policies and procedures, understaffing, and manual processes that lacked technology. Huge backlogs existed throughout the organization and over three dozen clinics were decentralized by location and process. Self pay patient billing was in a backlog status as well.

The Solution

ESI's top priority was to eliminate the backlogs and provide trained staff to take over the entire outpatient revenue cycle by accepting paper encounter forms and automating the process through scanning and OCR technology. ESI provided onsite staff to retrieve the paper encounter forms. Our Call Center Team scanned encounter forms and through OCR technology, coding queues were populated for our Coding Team to work.

The Coding Team utilizes coding technology for accuracy of billing/reimbursement. Our trained Billing Team then created clean claims through claim scrubbing technology prior to submission to payors.

ESI’s Collection Team performed follow up activity on outstanding claims in order to get the claims paid.

A Denial Management Team was also created to perform appeals and resubmission of claims for additional or missed reimbursement.

A Call Center was created in order to bill self-pay patients for their portion of the healthcare bill. Through trained customer service representatives, patients can now obtain information about their bill and provide additional information to get the bill paid.

The Result

Our client obtained an additional $100 million in incremental revenue for one year. This enabled the client to achieve their budget goals for the year and improved their profitability tremendously. Patients were informed and ultimately, satisfied.

As this relationship has continued to grow, our client has outsourced more revenue cycle areas to ESI and continues to achieve their ongoing target revenue goals.