Children’s Hospital Oakland faced a major revenue cycle challenge when it sought to convert to Epic from its old Meditech IT system. To avoid the receivables nightmares that can accompany computer conversions, the hospital’s senior team wanted to work down its existing self-pay account balances before making the switch to Epic, so that key managers could focus on the new system build and conversion. During the transition, the hospital also wanted to maintain a high standard of customer service with inbound and outbound calls and all patient communication.
After a careful review, Children’s chose Nashville-based Xtend Healthcare. “Xtend has worked with a number of West Coast providers with great success,” Drown says. “They bring on a team of expert project managers and on-site staff to keep the communications and AR decisions timely and effective.”
When the project started in September 2013, the Xtend team began working through a backlog of inventory. The team also made recommendations to resolve aged A/R and put in place processes to enhance workflow.
“With so many hospitals transitioning to new systems at the same time, it is fortunate that we had the full resources of a good vendor partner that allowed us to focus on our new system — knowing our legacy accounts and patient customer service were in good hands.”
What made the A/R reduction objective at Children’s especially challenging was the nature of its patient base. “The fragile nature of our pediatric patients and the trauma for their families are key focal points for our hospital,” Drown says.
For one thing, she explains, when children are hospitalized, the family’s resources often are stretched thin. Parents may have to take time off from their jobs, which in turn may affect their financial situations. These financial difficulties may be compounded when pediatric patients need long-term care with recurring, high-cost treatments that cannot be postponed.
Moreover, because many care decisions for the hospital’s patients must be made at an accelerated pace, parents often have difficulty keeping up with the paperwork. Communication between parents (and, often, step-parents) becomes an issue. Especially when children are admitted as the result of a health crisis, Drown says, “the family is often unprepared to identify the correct payer source, particularly if the health plan subscriber is not a custodial parent. Often, the non-custodial parent becomes the guarantor but is not able to get good communication with a custodial parent. And, due to the stresses on the family, keeping up with the administrative burden of interacting with payers to resolve eligibility is often very difficult.”
On top of everything else, notes Xtend’s Mindy Scher, with a Children’s hospital “you must be aware that you’re often communicating with or about minors, so you must be very conscious of privacy issues and areas of medical sensitivity.”
All of these factors made it imperative for Children’s Hospital to select a partner that was prepared to work through such obstacles. “Responsiveness to the family and their concerns is an important requirement for us, “Drown says, “and the staff at Xtend were prompt and worked pro-actively to keep the relationship transparent to the family.”
“In addition to a partner assuring cash flow,” she says, “having a partner who is invested in the best customer service for our patients has been invaluable. It provides a connection for the patient for immediate and prompt response to any insurance or private pay issues and the ability to have a number of creative payment options for resolving their account balances.” -- Gloria Drown
Xtend’s team, which became a seamless extension of Children’s business office, worked with families to help identify the correct payer for each case. Particularly valuable are Xtend’s automated charity, propensity-to-pay scoring processes. In addition, their automated, ongoing demographic processes to patients’ phone numbers, addresses and other key attributes, enable the hospital to ensure the patient contact is as accurate as possible.
“We had listed a number of accounts as private pay for which Xtend, after their screening process, discovered other Medicaid resources,” Drown says. “This has been very effective as a safety net for our billing.”
Meanwhile, she says, Xtend used leading-edge technology to “hit the ground running with inventory reduction as soon as it placed” and concentrated their work efforts to ensure a high percentage of collectability. In addition’s Xtend’s Saturday hours and extended daily office hours increased the collections window for the hospital.
While the engagement with Children’s Hospital is ongoing, the results to date of Xtend’s efforts to recover self-pay balances have been impressive:
Xtend has helped us increase our cash flow, reduce the days in A/R, and improve the efficiency of our business operations.
We needed a trustworthy partner that could provide a customized solution addressing our unique revenue cycle needs, guarantee results, use our specific processes and procedures, and respond quickly. Xtend delivered all of these.
A rare find in today's market.
The result was miraculous. Over a five-month period, Xtend managed to reduce our A/R by over 50%. They were invaluable in their feedback to our billing staff and our follow-up staff.