Hospital Industry Experience Is Key to Delivering Value
When the goal is to improve top- and bottom-line performance while maintaining high quality patient care and an exceptional patient experience, it’s essential to seek professional services from specialists with expertise in the healthcare industry.
Crowe Horwath LLP’s nationally recognized thought leaders have the knowledge to help your healthcare organization anticipate and respond to regulatory changes, improve operational performance, and manage risk. Our healthcare practice combines deep industry knowledge, functional process expertise, and applied technology to create unique, results-oriented solutions.
Crowe is an active member and regular contributor to the various national, state, and local healthcare organizations and associations, such as the Healthcare Financial Management Association (HFMA). Through our commitment to such organizations, we provide thought leadership and advice in areas such as revenue, operations, and risk management.
Crowe continues to develop solutions that exceed client expectations, illustrating the benefits that our industry experience and applied technology can bring to your hospital or health system. Our solutions include:
Revenue Cycle Analytics
Crowe’s Revenue Cycle Analytics (RCA) can help you support net revenue reporting and budgeting, estimate accounts receivable reserves, streamline the month-end closing process, identify revenue cycle opportunities, and strengthen internal controls. Crowe’s RCA solution delivers the valuable information you need to monitor, analyze, and report across multiple facilities. Trend analysis, insight into unusual activity, and standardizing reserve estimation can save your team a significant amount of time every month and will provide you with automated analytical reports not previously available.
Hundreds of hospitals and health systems, physician practice groups, long-term care facilities, and ancillary support service providers rely on Crowe to help create a healthier bottom line for their organizations with financial, tax, operational, and compliance solutions. In fact, many of the largest health systems in the United States already use RCA to focus on healthier financial results. For example, St. Vincent Health, Inc., a member of Ascension Health, the nation’s largest Roman Catholic healthcare system, had four patient billing systems that were not interlinked, limiting access to critical data. Crowe’s RCA solution resolved the initial challenge of disparate systems, added automated hindsight analysis, accelerated monthly financial closings, reduced the risk of material misstatement of financial reserves, and provided system-wide monitoring of revenue cycle activity in close to real time.
Credit Income Recovery and Balance Management Solutions
The Crowe Credit Income Recovery (CIR) and Credit Balance Management (CBM) solutions emerged after Crowe healthcare consultants and professionals specializing in state tax and escheat laws identified a genuine business need. Crowe’s multidisciplinary team collaborated with application developers in Crowe’s performance practice to develop software to benefit healthcare organizations suffering from large unresolved credit balances. Large hospitals and healthcare systems have seen significant efficiency gains resulting from this solution, which automates the review of large amounts of data so healthcare organizations can reduce outstanding credit balances.
To date, Crowe has been engaged in more than 3,000 provider credit reviews, worked in all 54 reporting jurisdictions, reviewed credits totaling more than $230 million, identified in excess of $54 million in exempt credits, recovered $1.1 million from states’ unclaimed property coffers, and performed liability assessments and Voluntary Disclosure Agreements (VDAs) with multiple reporting jurisdictions.
Charge Capture – Case study
After implementing a new clinical and financial information system, a 760-bed academic medical center experienced a steep drop in patient revenue – particularly evident in pharmacy, one of its highest revenue generating areas. Crowe’s charge capture specialists were brought in to help identify the issues that led to the revenue decline and design new processes to ensure all administered services and drugs were being recorded. Crowe performed rigorous assessments of eight key clinical departments, noting many instances where services were recorded but not linked to the new information system. In addition, Crowe helped identify several clinical services which were not recorded properly but were, in fact, reimbursable. Overall, more than $50 million in annual gross revenue ($15 million in net revenue) was identified.
Bad-Debt Management - Case Study
A 299-bed, $753-million gross patient revenue service hospital engaged Crowe healthcare professionals to help the hospital manage its bad debt better. Uncompensated care for hospitals is trending higher than previous benchmarks, which challenges management to make up for this shortfall with more aggressive collection techniques or more sensitive cost reduction strategies. Learn how Crowe helped this hospital appropriately categorize the “bad-debt” patients who can pay, but don’t, and helped create mechanisms and expectations for payment, which resulted in greater collections and lower bad-debt expense.
Denials Management – Case Study
An 840-bed university medical center asked Crowe healthcare professionals to help the center reduce its claim denial rate and increase its revenue. Submitting claims to third-party payers often yields less than full payment, despite best efforts. Crowe’s industry experience indicates that hospital providers typically have post-adjudication denial rates of eight percent or higher and final denial rates (lost cash) of two to three percent. The account rework generated by the former, and lost revenue represented by the latter, indicate the need for a comprehensive denials-management program. Learn how Crowe helped this medical center reduce its denial rate from 21 percent to 11 percent in 13 months, secure $3.7 million in additional cash, and reduce days in accounts receivable by almost eight days.
Managed Care – Case Study
One Crowe healthcare client was forecasting a current-year net revenue budget shortfall as it began its budget planning process. The Chief Financial Officer commissioned an assessment, looking for top-line revenue generating opportunities. The assessment included an evaluation of the managed care portfolio and underlying negotiations, strategic pricing deployment (Charge Description Master (CDM) adjustments), and clinical cost saving initiatives. Crowe developed intermediate and long-term strategies to align clinical initiatives, payer negotiations, and strategic price adjustments. This unique approach documents pricing objectives, improved communication, and creates a framework to measure opportunities.