Case Study: Healthcare
Dramatically exceeding collection and resolution goals on very aged accounts
Sagility collects $40M for the client against a goal of $30M
High aged A/R balances
How we do it:
From 2012 through 2014, Sagility’s scope of work included the resolution of non-government primary insurance A/R aged greater than 120 days. Sagility employs seasoned, talented staff, with domain expertise gleaned from nearly 20 years focused on RCM. These team members employ workflow innovation, industry knowledge, and tools such as our request tracking system (RTS) and claims management system (CMS) workflow and other best-in-class industry add-ons.
Sagility collected more than $40 million on the goal of $30 million, a performance metric of 133% of goal. To date, we have achieved a 28% payment recovery rate on very aged receivables. Additionally as a result of the denials and process feedback we provided (in conjunction with similar efforts internally at the client), the client was able to improve their performance on the less than 120 day A/R. With Sagility’s help, the client also expanded the focus area for their internal team to include all A/R less than 180 days.
Reducing a consistent backlog
How we do it:
With a strong focus on identifying and fixing inaccuracies in billing and claims processing, Sagility provided value-added services such as denial root cause analytics to provider staff, including patient access, patient accounting, health information management (HIM), clinical service delivery teams, and physicians and other caregivers. With these measures, Sagility helped the healthcare provider partner maintain compliance with payer guidelines. Sagility also aggressively challenged denials, looking for reversals as an activity and goal, a core resolution tactic the client had not employed previously. We also initiated daily, monthly, and quarterly reporting to bring insights to better drive higher clean claims processing to all payers.
As a result of Sagility’s efforts, the client’s resolution days decreased from 158 to 29 days, an 82% improvement.
28%collection rate on aged receivables
96%Resolution on open receivables
$195mcleared out of $203 million
$40mcash collected against the goal of $30 million
Resolution days decreased to
29daysfrom 158 days
Sagility works closely with this client to provide improved cash performance, solid reporting, and useful insights into process and outcomes improvement. The client trusts Sagility to deliver their inhouse health system managerial financial reporting. And Sagility’s business intelligence for the client is showcased to the client’s senior leadership on a consistent basis, as we share with the client their A/R strengths, weaknesses, and opportunities. Currently, we are in discussions with the client to employ robotic process automation (RPA), and other solutions among many in our DigiCX arsenal. There is potential to build on our success for significant efficiencies with this technology.