Case Study
Accelerating Revenue Cycle Performance for Measurable Financial Gains
- Challenge: Outdated systems and manual processes were impacting revenue cycle performance. Leaders wanted to tackle high denial rates and growing A/R backlogs with greater visibility into key metrics.
At a glance
Pender Community Hospital
- Facility: Critical Access Hospital
- Location: Pender, Nebraska
- EHR: MEDITECH Expanse
- Services Provided: Outsourced revenue cycle management, KPI alignment, dashboard strategy, staff training, process redesign
Key Outcomes
- Gross days in A/R dropped by more than half year over year
- Insurance denial rates declined by more than 71% compared to the previous year
- Cash collection increased from an average of $1.5 million per month to $2.8 million per month
This has been an invaluable partnership thus far, and Pender owes much of the recent success in the reduction of A/R to Tegria. I’m confident that we will look back and consider this one of the best decisions we’ve made to secure our future.
KIM HIXSONCFO, Pender Community Hospital
Background
Pender Community Hospital, located in Pender, Nebraska, has been an integral part of northeast Nebraska since 1913. An award-winning 21-bed critical access hospital, Pender offers a wide range of healthcare services, utilizing innovative technology that rivals any larger healthcare system.
Navigating the challenges of a rural healthcare environment with intricate payer structures demands a revenue cycle management system that is both agile and resilient; however, Pender’s outdated systems and reliance on manual processes hindered their revenue cycle performance. This resulted in elevated denial rates, significant A/R backlogs, and limited visibility into KPIs.
Solutions
As a critical access hospital with rural clinics, Pender faced challenges in achieving financial and operational efficiency due to complex payer rules and a lack of proper tools. Tegria took on Pender’s revenue cycle management functions, including billing, coding, revenue integrity, cash management, and leadership. As Pender’s outsourced RCM partner, Tegria assisted its teams in leveraging MEDITECH by reviewing and understanding their claims build and their clearinghouse. The analysis offered insights needed to transition billing routines back to the EHR system and to review their charging processes. By defining specific problems, measuring key metrics, analyzing root causes, and implementing solutions and controls, Pender gained a clear picture of their financial health and celebrated their improved revenue cycle performance.
Tegria’s expertise was instrumental in transforming our revenue cycle management. Their collaborative approach and deep understanding of MEDITECH’s capabilities enabled us to streamline workflows and enhance financial performance.
LAURA GAMBLECEO, Pender Community Hospital
Today, Pender continues to educate their staff to ensure EHR data is clear and actionable. By redefining productivity within their organization and adopting appropriate technology, they have positively impacted their financial performance while enhancing their commitment to quality patient care.
Results
By adopting a data-driven approach and tracking HFMA-aligned KPIs, Pender was able to establish realistic performance targets and drive improvement.
- Nearly 55% decrease in gross days in A/R
- 49% decrease in insurance-only days in A/R
- 34% decrease in A/R > 90%
- Nearly 73% decrease in A/R > 180%
- Over 71% decrease in denial rate
- Nearly doubled monthly cash collections to $2.8 million