At a Glance

Background and Challenge  

Tegria partnered with a healthcare system in Pennsylvania to perform an in-depth Revenue Cycle assessment. The assessment focused on the hospital system’s contact center, front-end operations, and patient financial services. This highly-ranked over 500-bed hospital system sought technical and operational improvements that would create and maintain a self-sustaining, peak-performing revenue cycle. In collaboration with their leadership, Tegria identified opportunities to increase revenue, ensure patient retention, invest strategically, and improve the overall patient experience.  

Solution 

Tegria deployed a cross-functional team of experts to assess the organization’s revenue cycle, from a technological and operational perspective. The technical investigation identified opportunities to enhance automation, improve reporting capabilities, and modernize system functionality. The operational investigation identified long-term solutions, which included aligning best practice staffing, implementing and enforcing accountability, and establishing a streamlined governance structure. 

Highlights of Tegria’s recommendations include:  

• Contact Center:
  • Establish governance structure
  • Optimize phone system and related reporting
• Registration & Eligibility:
  • Consolidate and automate payer and plan records
  • Implement full EHR functionality
• Financial Services:
  • Improve follow-up and denials management processes
  • Accelerate CFB and PB claim edits
  • Implement automation to decrease credit liability  

Results

Tegria’s comprehensive assessment identified and documented more than 40 themes and findings and presented 98 detailed recommendations with estimated benefits. Highlights include:   

• $29 million in annual net revenue opportunity 
• $17 million in cash acceleration opportunity 
• $5 million in denial improvement opportunity 
• $1 million in cost reduction opportunity  
• 14 FTE bandwidth increase with recommended changes