Lower A/R days, fewer denials, and increased paid claims
Editor's note: The following is included in NAHRI's 2020 State of the Revenue Integrity Industry Report. Click here to read the full report and participate in 2020 Revenue Integrity Week activities.
Adirondack Health came to TruBridge after discovering they could save money over their previous clearinghouse. “We had a new director come in who’d been using a few of the revenue cycle management (RCM) product modules from TruBridge in his previous hospital,” says Adirondack Health Patient Financial Services Analyst Mark St. Dennis. “The cost savings was the main reason we decided to switch to TruBridge.” However, due to the seamless integration to Meditech as well as other product capabilities, the following benefits revealed themselves:
- 20% decrease in A/R days
- 40% reduction in denial rates
- $125,000 recovered in underpaid claims
- 22% increase in paid claims
Adirondack Health uses the full suite of integrated TruBridge RCM product modules, including claim scrubbing and submission, ERA retrieval, remittance management, denial and audit management, eligibility verification, and contract management. “We’ve also incorporated the Medicare Navigator module, which is really easy—one login, one system,” says Kathy Bauer, director of patient financial services at Adirondack Health. “And it costs less than what we were using prior.”
According to St. Dennis, it has been a good experience from the start. “With the help of the TruBridge experts and our dedicated staff, the overall improvement in key areas of the revenue cycle has exceeded our expectations.”
Decrease in A/R days
A quality RCM solution plays an important role in ensuring healthcare facilities get paid every dollar they deserve from both patients and payers. Since implementation, the TruBridge RCM product, including its integration to Meditech, has helped steadily decrease Adirondack Health’s gross A/R days. The bottom line is that TruBridge RCM has helped Adirondack Health get paid faster while improving efficiencies across many areas of the revenue cycle.
Increase in paid claims and reduction in denials
With the TruBridge RCM product and additional process changes, Adirondack Health has experienced a 22% increase in paid claims. “We’ve found tremendous efficiency gains in the audit management module. Essentially, we have one individual who is our appeals and audit coordinator,” says St. Dennis. “She’s been incredibly impressed with the ability to track and manage claim appeals and, as such, we’ve seen significant improvements in our auditing, tracking, and appealing of denied claims.”
While the increase in paid claims has been great, the best way to increase efficiency while still getting paid is to reduce the percentage of claim denials and the related effort to manage them. The TruBridge RCM suite has endless flexibility and customization on a payer-by-payer basis. This capability has enabled a 97% first pass clean claim rate, which specifically relates to the 40% reduction in denied claims. Simply put, “the TruBridge RCM suite has allowed us to operate more efficiently, saving us valuable time and money managing the ever-increasing complexity of healthcare billing,” says St. Dennis.
Recovery of contract underpayments
Once live on the core TruBridge RCM modules, Adirondack Health added the contract management module. Since the module can compare payer contract terms to actual paid claims, Adirondack Health was able to identify a variety of underpayments. In fact, in the first 10 months, they identified one payer that had been underpaying claims by 2% for more than two years, and a second that was underpaying by 3% over a six-month period. With information and data to support their case, Adirondack Health successfully negotiated a settlement payment of $125,000 for the underpaid claims.
St. Dennis shares that the TruBridge contract management module provided a nice mix of technology and data that allowed Adirondack Health to compare contract terms against actual paid claims. “Having better tools to manage contracts and the related leverage to hold payers accountable will continue to help us get paid every dollar we deserve from our payers.”
TruBridge RCM suite
TruBridge offers a superior RCM product that consists of a suite of integrated web-based tools designed to further improve the financial health of healthcare organizations of all sizes. Contact us for help increasing your paid claims rate and decreasing the amount of time it takes to manage this complex process:
3725 Airport Blvd.
Mobile, AL 36608