Consolidated Health Services: New Technology Improves Denial Prevention

sgruber-200 (1)By Sarianne Gruber
Twitter: @subtleimpact

Consolidated Health Services would agree that to stay financially healthy – especially when it comes to preventing denials, means investing in a better technology solution for receivables management.  I had the opportunity to interview Don Hoskins, Revenue Cycle Support Manager from Consolidated Health Services (CHS) and learn about the challenges his department was facing and how transitioning to single platform improved his team’s performance and denial collections.  Headquartered in Milford Ohio, CHS is a leading home health and hospice provider for over 35 years, with over 50 branches throughout the country.  Home health services include nursing, medical social work, and home health aides, as well as medical equipment, non-emergency transportation, plus physical, occupational, speech and infusion therapies.

Curious to know the challenges CHS were facing whether they were financial, time or workflow, I asked Mr. Hoskins what was the tipping point for seeking new technology for denial and appeal management.  He told me their Performance Management system did not allow them to post denial information during the remit posting process. They had no site lines to the root cause of their Accounts Receivable (AR) issues. They were forced to have their collectors work on denials in Excel workbooks based on aging reports.  A big drawback was “this method didn’t lend itself to analytics because it was so cut up and segregated across the department.” He did mention that some [data] were sorted by branch and others by payers and the only focus was on the dollar amount collected. I imagined this must have been a slow, tedious process with a high risk for mistakes.  Next, I wanted to know more about CHS’s journey from denial management to denial prevention.  I learned their new “Denial Tool” allows the user to organize and trend factors across providers and insurance companies as well as across services. It allows you to answer questions like is it a single branch issue, is it a unique issue across branches with a single insurance company, or maybe it’s an issue with a particular type of service across all branches and/or all payers.  “These lines of site,” explained Mr. Hoskins “allows one to spot the trend and get out in front of it through training and education, etc.”

[tweet_box design=”default” float=”none”]Interview w/ @CHI_Updates looks at their journey from denial management to prevention @subtleimpact @ZirMed[/tweet_box]

Upgrading from Excel spreadsheets to a new single platform AR management solution certainly must have improved the team’s work and performance. I wanted to know a bit more details. Mr. Hoskins provided some examples.  He said it allowed them to rearrange the department to put the focus on collections and less on claims management.  Each day a collector can look at the assigned workcenter and see exactly what is new and prioritize the work schedule based on volume or dollar amounts, etc.  They have been able to expand into two new markets without having to add staff.  “Additionally, we plan on adding several new sites in the coming year,” affirmed Mr. Hoskins, “and we believe with the efficiencies we have that we will not need to add to our current headcount.”  Has there been an impact on the management process with new technology?  “Now that we have our customized denials work queue established across the department, we have been able to re-organize our department to enable a more concentrated effort on collections and less on straight billing,” responded Mr. Hoskins.  As for improvement in efficiency, he also shared, “We have removed the task of creating the initial claims file from our billers and placed it with just a few individuals, leaving the majority to focus on denials research and collections.”   And finally, has improved technology helped in working with your payers to decrease denials?  “The new technology has helped our Managed Care Group more skillfully escalate issues with our assigned Provider Reps,” recounted Mr. Hoskins.  With accessible data, the Managed Care Group can now quantify the impacts and provide actual examples of the problems they are seeing.

From my discussion with CHS’s Revenue Cycle Support Manager, no doubt, successful users of new technology will be industry-leading performers in receivables management. At CHS, the revenue cycle support consists of Mr. Hoskins and 5 analysts as well as over 50 billers and collectors. Pairing an RCM team with AR management solution, exemplified by Mr. Hoskins, can improve efficiency, save staff time and minimize mistakes.

About Don Hoskins
Don has over 15 years of Accounts Receivables experience including the past 6 years in Healthcare Billing. He has served as both a Director of Billing Operations for a regional laboratory company and Manager of Revenue Cycle Support for a national home health company, with a heavy concentration on process improvements, analytics/reporting, mergers/acquisitions and system integrations.

This article makes reference to ZirMed’s Denial and Appeal Management tool used by CHS. Read the CHS Case Study.