Improving denial rates adds up to big bucks

Sentara Healthcare decreased weekly eligibility-related denials by 7 percent and reduced incorrect insurance denials by 16 percent, reducing write-offs by roughly $1 million over a five-month period. Andy Weddle, vice president of revenue cycle at Sentara Healthcare, and Ed Caldwell, senior vice president of revenue cycle services at Emdeon, will lead a 7 a.m. early riser session, “Sentara Healthcare: Using Technology and Professional Services to Efficiently Manage Uncompensated Care,” on Wednesday, June 27 and discussed the success story with Healthcare Finance News Editor René Letourneau.

Q: What were the main keys to Sentara Healthcare's success in making such drastic improvements to the revenue cycle?

AW: With a growing self-pay population and changing regional demographics, Sentara’s in-house eligibility and enrollment program was struggling to keep up. One key component of Sentara’s success began with bringing in third-party eligibility specialists from Chamberlin Edmonds, an Emdeon Company, to handle patient screening and enrollment for various government coverage options, such as Medicaid, Supplemental Security Income and Social Security Disability Insurance. These specialists work on behalf of the patient as an advocate to secure coverage and ensure that the hospital is properly reimbursed for medical services.

EC: By outsourcing this process, Sentara staff has more time to handle core responsibilities. The second step was to implement a robust revenue cycle management technology, called Emdeon Assistant, to streamline the front-end eligibility verification process and assist in denials reduction.

Q: What will be the biggest takeaways for session attendees?

EC: Session attendees will understand the benefits of a comprehensive approach to hospital revenue cycle management. Tackling RCM challenges with both professional services and technology allows the hospital to continue providing patients with the best care possible, while increasing efficiency and improving the health of its finances. Outsourcing can enable the hospital to provide a community benefit to its self-pay patients, while also ensuring that coverage is secured and the hospital is properly reimbursed.

AW: At Sentara, it became clear that, along with adding professional services to the revenue cycle management process, a complementary IT solution was also necessary. By implementing technology that can instantly verify eligibility for patients, resources can be focused on the patients with the greatest need.

Q: What advice do you have for other providers looking to make similar progress?

AW: Know your patient population. With current economic conditions, it’s not uncommon for hospitals to see the proportion of self-pay patients increase, regardless of geographic location. Understanding how your organization and your patients stand to benefit will help inform you as to what proactive combination of RCM programs you should look to implement.

Andy Weddle is the vice president of revenue cycle at Sentara Healthcare, based in Virginia, and Ed Caldwell is the senior vice president of revenue cycle services at Emdeon.