Sentara hired Chamberlin Edmonds in 2001 to take over its revenue-cycle functions for all of the system's 10 hospitals.
Andy Weddle, vice president of revenue cycle for Sentara, said the system's growing uncompensated-care burden fueled by high rates of self-pay patients prompted the system to turn to outside help. In 2011, Weddle said, Sentara's community benefit costs were $176 million, which includes $145 million in uncompensated care. Uncompensated care is the total of bad debt and charity care.
One of the major problems, according to Weddle, was the fact that each of Sentara's hospitals performed revenue-cycle responsibilities in different ways with no standardization or expertise. Some were doing it in house, some were doing it through social services agencies and some were using outside vendors, he said.
“It was excuse after excuse after excuse after excuse,” Weddle said. “So we turned to an excuse-management technique—outsourcing!”
Specifically, Sentara needed help with getting eligible self-pay patients enrolled in Medicaid and other state-assisted insurance programs, according to Weddle. And, the system needed more sophisticated ways of doing insurance verification, he said.
“Our employees hated it, and our numbers stunk,” Weddle said.
With outside help, Sentara generated more than $229 million in Medicaid revenue in 2011 of which more than $100 million came from eligibility work performed by Chamberlin Edmonds.
Ed Caldwell, senior vice president of provider services at Emdeon, said the “session was not a sales pitch” but proceeded to highlight the names of the firm's prominent health system clients. “The names speak for themselves,” he said.
The session was one in a series at the conference that highlighted an HFMA peer-reviewed vendor and one of the vendor’s clients.
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