Success story: Mid-Atlantic client

Maintaining cash flow during an electronic health record (EHR) system conversion

Situation and challenges

Imagine needing to transition five hospitals and three physician practices off their respective legacy EHR systems and onto a single, centralized system. That was the challenge facing a Mid-Atlantic client, an integrated health system serving communities across two states. They employ more than 1,000 physicians — and more than 15,000 people overall — across advanced practice clinics, a home care organization, six hospitals, and more than 125 patient care locations.

In 2014, our client had committed to implementing a common EHR system across their organization, selecting a prominent vendor. They knew it would take a few years to achieve their goal of a unified system and that they would face steep challenges along the way:

  • Their facilities were using several disparate legacy systems (e.g., Allscripts-Eclipsys, Flowcast/E-Care, Medent, Meditech, and Paragon);
  • The investment was nearly $200M;
  • The conversion would heavily impact many departments, notably IT and the central business office; and
  • During the transition, our client needed to anticipate and minimize disruptions to patients, employees, and cash flow.

They realized that partnering with a leader in revenue cycle management (RCM) during that time would give them their best chance at success.

Actions and solutions

More than a year before their EHR transition began, our client vetted eight potential RCM providers to work their legacy A/R inventory during the EHR conversion. They ultimately selected us because:

  • We brought scale and could adjust staffing up and down as needed, ensuring stability during the change;
  • We brought deep system expertise with both their new and legacy systems, so we understood their EHR vision and could provide knowledge and consultation in support of their goals;
  • We had successful client relationships with other healthcare systems in the same geographic area, so we understood the local payor environment and communities;
  • We could apply claim-coding expertise, ensuring quick and accurate payment and appeal processes for the healthcare system and its hospital patients; and
  • We could get up and running quickly, integrating ourselves across many systems, teams, and workflows while providing clear and timely reporting.

With the Xtend partnership in place, our client could proceed with confidence, knowing their cash flows would be protected as they embarked on their mission-critical EHR conversion.

Beginning in early 2017 — three months before their East region facilities were scheduled to begin their EHR conversion — our client kicked off phase 1 of their A/R resolution process by placing legacy inventory with us from the region’s two physician groups and two hospitals. The initial accounts were aged receivables. Our client’s strategy was to assign new inventory to Xtend every 30–60 days, starting with the oldest.

Phase 2 began in earnest in the spring of 2017, with the late-fall EHR conversion date looming. We began working legacy inventory from our client’s West region facilities: the remaining three hospitals (including their flagship hospital) and the remaining, largest physician group.

By early winter — a month after the EHR transition was successfully finalized across all facilities — our client began placing remaining legacy A/R inventory with us. The account types included commercial, managed care, government, workers’ compensation, facility/hospice/county/prison, and VA/Tricare.

“We’re committed to helping all our clients meet their commitments to their patients, people, and communities. We are proud to have supported this client through their successful EHR transition and to continue supporting them in achieving their revenue cycle goals.”

— Mike Morris, Chief Executive Officer of Xtend Healthcare


Our engagement with this client continues to this day, and we are proud of the results we have achieved. As of early 2020, we have resolved more than 94% of the accounts assigned to us, collecting more than $118M or almost a third of the total amount resolved ($364M).