Nathan Adelson Hospice developed a strategy that reduced our accounts receivables over 90 days by 80% in the first six months. Was the approach totally revolutionary? No. It was as simple as revisiting and recommitting to the basics of successfully managing accounts receivable.
Nathan Adelson Hospice
Nathan Adelson's mission is to provide patients and their loved ones with comprehensive end-of-life care and influence better care for all in our community. We honor the importance of choice and control for those who are ill so they may define for themselves the most comfortable and dignified manner in which to live.
As a not-for-profit hospice provider based in Las Vegas, Nathan Adelson strives to achieve a balance between the business aspects of hospice and our mission. Improved cash collections as a result of a strong accounts receivable management policy positions our organization to provide ongoing care to our patients and families at the most critical time in their lives.
We determined several factors that were intrinsic to effective management of our receivables:
- Establish a commonality between the finance objectives and our clinical mission.
- Know our insurance contract potential.
- Target specific challenges to timely billing and collection within our organization.
- Develop simple tracking tools for monitoring activity and results.
- Empower our billing team and set expectations for positive results.
Expectations for positive results were set:
- Reinforced the importance of effectively managing the accounts receivable to the continued success of the organization.
- Created teamwork between departments by establishing ownership of common issues.
- Encouraged consistency in following the process in spite of time constraints or conflicting priorities.
- Acknowledged departments/employees whose extra efforts contributed to success took place.
- Established and communicated the correlation between extra efforts and improved results.
Commitment was organizationwide and started from the top. We used every opportunity to educate and garner support from the management team and staff by attending meetings at all levels. The accounts receivable goals were quantified in terms that each group could internalize.
A periodic review of our existing contract base for “negotiating potential” was implemented. We communicated contract information to all areas of the organization and highlighted collaboration efforts in negotiating new or improved contracts. Relationships with case managers and human resources benefit team members were developed, and we identified and explained what differentiates our hospice from competitors. We educated employers on the value of providing hospice benefits to their employees and the potential financial savings to the company. We never assumed a specific payer or employer was off-limits.
An impediment to effective accounts receivable management was the untimely billing of charges. We established timelines for submitting timesheets and billing charges within the finance and clinical divisions. Accomplishments and failures of each billing cycle were communicated to all responsible staff and management and we incorporated compliance into performance expectations. Consistent follow-up was vital to our ongoing success.
Tracking tools focused on those issues that had been identified as challenges. For example, reports explaining variances between expected and actual billing dates and dollars billed were used to identify when snags were occurring. Dollar amounts by specific issue were highlighted. A weekly analysis of all balances over 90 days allowed us to review actions taken over a period of time and identify problems requiring additional investigation. Communication of issues between billing staff and the admission department was mandated.
The billing staff was trained to identify and proactively address external issues early in the billing process. They were supported in their efforts to resolve issues with co-workers and payers and recognized for their individual and team accomplishments.
One example of how our new strategies and philosophy changed work functionality is that historically, the finance department had the task of being the only staff members to contact and work with insurance companies. Through effective staff collaboration, and shift in establishing a commonality between the finance objectives and our clinical mission, the admissions team began making the initial contact with the insurance companies. While this does not seem like a major paradigm shift, we know that changing roles and responsibilities can create their own challenges. We found that connecting the admissions team with the insurance company eliminated some of the clinical documentation issues related to billing, thereby reducing authorization and claim payment delays.
Getting back to the basics required a commitment from the whole organization. Was it worth it? We think so.
Dawn Metcalfe is vice president of finance and administration for Nathan Adelson Hospice, Las Vegas.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.