We were contracted by one of the world’s largest healthcare group practices to assist in turning around its troubled revenue cycle that was failing to recover a high percentage of billings. Management believed that it’s outsource billing and collection vendor was performing poorly and asked us to help lead a remediation effort both inside the company and in collaboration with that vendor.
We documented the complex business process and information flows supporting the charge to cash cycle, along with the functionality of a custom developed charge entry and edit system that was being rapidly evolved with agile software practices. Our forensics identified numerous cases in which staff were continuing to classify billable charges into queues that the company’s own software had abandoned, leading them to time out and become unbillable. We changed the business process workflows, provided software design changes to the technical staff, and quickly recovered nearly $1 million in orphaned charges that the outsource vendor was able to process through to payment.