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Case Study New Hanover Regional Medical Center Issues Answers 888.511.7901 www.convergentusa.com/healthcare Page 1 New Hanover Regional Medical Center Improves Financial Performance with Attorney-Driven Approach to Workers’ Compensation New Hanover Regional Medical Center (NHRMC) is a teaching hospital and regional referral center for an eleven-county area in southeastern North Carolina. As a tertiary care center, NHRMC offers specialty medical and surgical care at the medical center and additional care at its women and children’s, rehabilitation and psychiatric hospitals. It is one of 10 trauma centers in the state certified at Level II or above. A public, not-for-profit healthcare system, NHRMC provides more than $140 million a year in charitable and uncompensated care. At New Hanover Regional Medical Center (NHRMC), as at many healthcare facilities, staff spent significant time and resources to resolve underpaid and denied Workers’ Compensation claims. The time spent on these challenging claims was not often commensurate with the results. For added support, NHRMC turned to Convergent Revenue Cycle Management, Inc. (Convergent) which the hospital recognized for its reputation as an expert in healthcare reve- nue cycle management and within this challenging financial class of claims. “We wanted a resource that would be fully dedicated to this set of claims, and we knew that Convergent and its team of experienced lawyers would be that resource for us,” said Deb O'Neill, Director of Patient Financial Services. “They have the in-depth knowledge of state-specific Workers’ Comp statutes and regulations that we needed to work our claims aggressively and resolve them quickly and appropriately.” For NHRMC, the transition to placing Workers’ Compensation accounts with Convergent was seamless and required very little effort. Plans for assigning claims were in place and Conver- gent’s on-site representative was there to ensure a smooth changeover. “We placed 100 percent of our Workers’ Compensation claims with Convergent, and they were ready to begin working them from day one. The transition was exceptional,” said O’Neill. Convergent began at once applying its proven process for managing Workers’ Compensation claims. For all high value accounts, this process begins with a legal review. Convergent works with both the state and the insurance carrier to check that all claims have been accepted as legitimate and all medical bills are on file. Critically, they ensure that the carrier has the necessary information from the state to initiate payment. Convergent uses advanced technology to calculate reimbursement amounts automatical- ly, based on the complex fee schedules for Workers’ Compensation claims. When more than one state is involved, Convergent is able to readily apply the correct fee schedule to the claim. Convergent then tracks actual payment amounts. If a payment is lower than calculated, Convergent immediately appeals the amount using persistent telephone contact and tailored letters that quickly get the attention of payers. Its attorneys stay fully up to date on state regulations and case law, enabling them to quickly determine when to pursue litigation. Convergent’s onsite representative serves as a liaison between the two organizations, gather- ing information and keeping the reimbursement process moving forward. “The representative that Convergent placed onsite works inde- pendently to handle our Workers’ Comp accounts. Our staff, in turn, is able to focus on accounts where they have the skills and knowledge to be highly effective,” said O’Neill. “We placed 100 percent of our Workers’ Compensation claims with Convergent, and they were ready to begin working them from day one. The transition was exceptional.” Deb O’Neill Director of Patient Financial Services New Hanover Regional Medical Center
Transcript of New Hanover Study Page 1 - Healthcare Financial … Hanover Regional Medical Center Case Study...New...
Case StudyNew Hanover Regional Medical Center
Issues
Answers
888.511.7901 www.convergentusa.com/healthcare Page 1
New Hanover Regional Medical Center Improves Financial Performancewith Attorney-Driven Approach to Workers’ Compensation
New Hanover Regional Medical Center (NHRMC) is a teaching hospital and regional referral center for an eleven-county area in southeastern North Carolina. As a tertiary care center, NHRMC offers specialty medical and surgical care at the medical center and additional care at its women and children’s, rehabilitation and psychiatric hospitals. It is one of 10 trauma centers in the state certified at Level II or above. A public, not-for-profit healthcare system, NHRMC provides more than $140 million a year in charitable and uncompensated care.
At New Hanover Regional Medical Center (NHRMC), as at many healthcare facilities, staff spent significant time and resources to resolve underpaid and denied Workers’ Compensation claims. The time spent on these challenging claims was not often commensurate with the results. For added support, NHRMC turned to Convergent Revenue Cycle Management, Inc. (Convergent) which the hospital recognized for its reputation as an expert in healthcare reve-nue cycle management and within this challenging financial class of claims.
“We wanted a resource that would be fully dedicated to this set of claims, and we knew that Convergent and its team of experienced lawyers would be that resource for us,” said Deb O'Neill, Director of Patient Financial Services. “They have the in-depth knowledge of state-specific Workers’ Comp statutes and regulations that we needed to work our claims aggressively and resolve them quickly and appropriately.”
For NHRMC, the transition to placing Workers’ Compensation accounts with Convergent was seamless and required very little effort. Plans for assigning claims were in place and Conver-gent’s on-site representative was there to ensure a smooth changeover. “We placed 100 percent of our Workers’ Compensation claims with Convergent, and they were ready to begin working them from day one. The transition was exceptional,” said O’Neill.
Convergent began at once applying its proven process for managing Workers’ Compensation claims. For all high value accounts, this process begins with a legal review. Convergent works with both the state and the insurance carrier to check that all claims have been accepted as legitimate and all medical bills are on file. Critically, they ensure that the carrier has the necessary information from the state to initiate payment.
Convergent uses advanced technology to calculate reimbursement amounts automatical-ly, based on the complex fee schedules for Workers’ Compensation claims. When more than one state is involved, Convergent is able to readily apply the correct fee schedule to the claim. Convergent then tracks actual payment amounts. If a payment is lower than calculated, Convergent immediately appeals the amount using persistent telephone contact and tailored letters that quickly get the attention of payers. Its attorneys stay fully up to date on state regulations and case law, enabling them to quickly determine when to pursue litigation.
Convergent’s onsite representative serves as a liaison between the two organizations, gather-ing information and keeping the reimbursement process moving forward. “The representative that Convergent placed onsite works inde-pendently to handle our Workers’ Comp accounts. Our staff, in turn, is able to focus on accounts where they have the skills and knowledge to be highly effective,” said O’Neill.
“We placed 100 percent of our Workers’ Compensation
claims with Convergent, and they were ready to
begin working them from day one. The transition was
exceptional.”
Deb O’NeillDirector of PatientFinancial Services
New Hanover RegionalMedical Center
888.511.7901 www.convergentusa.com/healthcare Page 1
Convergent provides NHRMC with ready support and self-serve solutions. “With the responsiveness of our account manager and the regular presence of our account executive, we receive an exceptional level of customer service.”
Less than 2 years ago, NHRMC converted to the EPIC system. Convergent made thetransition with them, applying its experience supporting other clients moving to and using EPIC. “This change was seamless, with no negative impact on Workers Comp collections throughout the transition,” said O’Neill. Convergent worked with the hospital to automate online reporting between its own agile system and the EPIC system. “We are now fully self-sufficient when it comes to assessing our Workers’ Comp book of business. We can pull our own reports and view details down to daily placements, transactions and notes,” said O’Neill. “Convergent offers us so much transparency that they consistently meet our needs.”
NHRMC continues to place all of its Workers’ Compensation claims with Convergent Revenue Cycle Management—claims valued at roughly $1 million a month. And Convergent continues to generate results, collecting an average of 70 percent on referred accounts. Since the engagement began in 2004, Conver-gent has collected more than $92 million for NHRMC, including four recent months when collections exceeded $1 million. For several months in 2012, Convergent collected 100 percent of denied claims with an average age of 505 days.
The benefits to NHRMC extend beyond the Workers’ Compensation book of business. “Convergent’s flexibility in making the transition to EPIC along with us helped to support our financial position,” said O’Neill. “And, by choosing Convergent, we’re able to reallocate our NHRMC team to other financial classes and current accounts, which contributes to improve-ments in our overall results for accounts receivable.”
Convergent is known for the professionalism of its people and their ability to work independent-ly to achieve results. “We’re very happy with our onsite liaison. She works directly with hospital staff to gather information, and does so independently,” said O’Neill. “This is such a successful partnership for us, from the seam-less transitions to the minimal involvement of management to the ready availability of infor-mation and reports. For all the financial and operational successes Convergent has helped us achieve, their rate is highly competitive. I would recommend Convergent unequivocally.”
Derek Pickell, CEO of Convergent Revenue Cycle Management, explained how its revenue cycle management services have helped NHRMC, “As a premier niche revenue cycle management partner, we pride ourselves on our low maintenance approach to outsourcing, the vast legal expertise we bring to Workers’ Compensation, motor vehicle and general problem claims and the ability to support our customers during major system conversions. These core strengths have helped NHRMC and many of our other customer partners to strengthen their financial position and continu-ally improve the services they provide to their patients. We always strive to be a true partner and an extension of our customers’ manage-ment staff.”
Outcomes
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“This is such a successful partnership for us, from the seamless transitions to the
minimal involvement of management to the ready availability of information
and reports. For all the financial and operational
successes Convergent has helped us achieve, their
rate is highly competitive. I would recommend
Convergent unequivocally.”
About ConvergentConvergent is recognized as the premier niche revenue cycle management company in healthcare, providing innovative solutions across the revenue cycle spectrum including patient access solutions, early out self-pay collections, attorney-powered third-party reimbursement and bad debt recovery*.
Our regulatory expertise and consumer focused patient contact center technology optimize revenue cycle performance and improve healthcare provider relationships with patients. The healthcare division has operation centers in Virginia, Texas, New York, Florida, and Illinois.
*Bad debt recovery provided by Convergent Healthcare Recoveries, Inc., an affiliate company.
Deb O’ NeillDirector of PatientFinancial Services
New Hanover RegionalMedical Center
