Proven results

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Business Office Case Study

The Queen’s Medical Center delivers $5M in cash improvements by ending the “claim status quo”

The Queen’s Medical Center is a renowned health system and Level I Trauma Center, recognized as a U.S. News & World Report Best Regional Hospital and Best National Hospital. With 500 inpatient beds and numerous auxiliary services, the business office stays busy following up on the status of hundreds of thousands of claims. Although the vast majority are approved, notification would not occur until 45 days after service when payment or denials would arrive in the form of remittances. Through her search for effective automation, she discovered that Recondo’s ClaimStatusPlusTM could rapidly obtain status on the health system’s entire inventory and identify claims that require manual intervention.

Business Office Case Study

Avera Health frees $2.1 million from claim status bottleneck

As one of the leading integrated health systems in the Upper Midwest, Avera Health cares for hundreds of thousands of patients across dozens of hospitals in South Dakota and surrounding areas of Minnesota, Iowa and Nebraska. Due to rapid growth, outstanding claims have steadily increased − creating a persistent backlog for staff to wade through. In response, Avera’s VP of Central Business Office Services, Mary Wickersham, ultimately led a reinvention of how her department verifies if a claim is approved or denied. During the first year under the new program, doing so has effectively liberated $2.1 million from a cash flow bottleneck, significantly reduced aged accounts, and enabled Wickersham’s department to close tens of thousands more claims at a new speed and scale— without adding more staff.

Patient Access Case Study

Mercy improves point-of-service collections with Recondo-Epic integration

The pressure is on for providers to collect more revenue from patients at the point of service. What’s holding them back is lack of clarity about how much the patient actually owes. Most hospitals are accustomed to seeking reimbursement from public and commercial payers, so the need for more visibility into patient financial liability is new territory. For Mercy, the nation’s fifth-largest Catholic health system, it’s an opportunity to equip patient access staff with tools that quickly generate accurate statements of patient financial responsibility. In the one year since Mercy began using Recondo’s BeneftsPlus™ benefit resolution service with its enterprise-wide Epic electronic health record (EHR), the Midwestern health system has increased patient point-of-service collections by 12% while significantly reducing staff time and improving the accuracy of patient estimates.

Patient Access Case Study

Atrium Health achieves 80% “touchless” accounts with patient access automation

High administrative costs continue to challenge hospitals across the country. Rather than reduce necessary services and staff to make up the difference, patient access executives like Katie Davis of Atrium Health are taking the lead in bolstering revenue performance by deploying automation across some or all of these transactions. In this newly automated environment, Atrium Health has improved pre-service collections by nearly $1 million while significantly reducing denied accounts and denied dollars.

One of the health system’s most impressive achievements was a sharp increase in “touchless” claims, those requiring minimal human interaction when calculating and communicating patient financial responsibility and authorization status checking. Specifically, the percentage of patient encounters that require manual intervention has dropped from 100% to less than 20%, freeing the highly skilled staff to focus on exceptions that pose the greatest denial risk.

Patient Access Case Study

St. Francis Hospital fast tracks front-end collections with automated patient pricing

St. Francis is a 376-bed regional health system with dedicated centers for women’s health and psychiatric care, the area’s only open heart surgery program, and numerous physician practices, staffed by 2,800 full-time associates and more than 300 physicians. Its growth is a testament to the outstanding and compassionate care patients have received over many decades. Yet further investments will increasingly depend on how well St. Francis weathers the significant cutbacks to insurance payments most hospitals are experiencing, particularly the sharp decline in Medicare reimbursements.

St. Francis’s Patient Access Services Director Linda Glass knew her staff had reached the limits of what they could collect based on manually created patient estimations. St. Francis needed an automated method to replace patient estimation processes that were no longer effective in the modern landscape of shrinking payer reimbursement and increased patient financial obligation. By adopting Recondo’s SurePayHealth™ automated patient pricing estimation, St. Francis has increased collections by another 37 percent, while equipping staff with the tools they need to continuously improve.