The Mount Sinai Department of Surgery first engaged Sutherland to help improve cash flow and target accounts receivable (A/R) over 90 days. In early 2011, Sutherland’s scope expanded into the Ambulatory Surgery Center (ASC) where rising patient volumes had created a number of pain points for the center’s internally managed billing operations, including:
- Lack of patient communication: During the pre-certification process, the ASC staff was not reaching patients directly to inform them of their financial responsibility and pre-surgical instructions. This resulted in missed appointments, late arrivals, and cancelled or rescheduled surgeries
- Incomplete pre-surgery verification process: Also due to poor pre-surgery communication, patients were not prepared to pay the co-pay and/or deductible on the day of surgery, leading to low time of service (TOS) collections and high A/R days
- High claims denial rate: Insurance pre-authorizations often contained errors and invalid information, resulting in a high percentage of rejected claims. There was no effective denial management system in place to adjudicate these claims
Sutherland revamped the entire patient access process, shifting it to a consumer-centered experience. The focus was not only on generating revenue, but on increasing the number of human touch-points prior to surgery to create a more customized, personalized patient experience. Solution Highlights:
- Improved patient communication and education – from reviewing pre-surgery instructions and date along with the time of arrival, to explaining the out-of-pocket financial responsibility and exploring payment plan options
- Implemented predictive analytics, decision-assist analytics, and a tangible performance management system to track key indicators such as gross collections rate (GCR), A/R days, and claims denials
- Initiated tracking of key performance indicators to ensure proactive management of A/R accounts and proper due diligence
- Created a “high dollar” team to specifically target A/R Days >150 for the ASC and A/R Days >180 for the Department of Surgery. A high dollar insurance follow-up specialist speaks directly with insurance network managers and supervisors to offer assistance with the collections
- Implemented a full-touch high dollar resolution strategy for self-pay cases. A high dollar case negotiator targets collections from self-pay and other non-insurance cases
Sutherland and our partners at Mount Sinai have yielded transformational, bottom line results.
“The Sutherland team has a thorough understanding of our needs and they are always looking for ways to improve. Their ability to live up to our standards has created the results you see today,” says David Kaplan, MPA, Vice Chairman, Administration and Finance for the Department of Surgery and Academic Instructor of Surgery at Icahn School of Medicine.
Mr. Kaplan believes the Sutherland-Mount Sinai model is a blueprint that is replicable in other surgical departments, ambulatory surgery centers, and physician practices across the country.