Stormy revenue cycle woes turn to clear skies and improved cash flow
CASE STUDY |
Founded as an orphanage for boys in 1916, Rosecrance is now a private, nonprofit organization, offering behavioral health services for children, adolescents, adults and families throughout the United States. With more than 20 locations in the Chicago and Rockford, Illinois, areas, Rosecrance offers comprehensive addiction services, including prevention, intervention, detoxification, inpatient and outpatient treatment, experiential therapies, dual diagnosis care and family education. The organization also offers high-quality, efficient and effective outpatient mental health services for children, adults and families through a variety of programs. Rosecrance serves more than 16,000 families each year.
Challenges and approach
As their mission statement indicates, Rosecrance is dedicated to providing help, hope and recovery to children, youth, adults and families. Over the years, as they continued to expand on this mission and their dedicated outreach of care, however, some growing pains began to emerge for them, as well. With the addition of new treatment locations, merged mental health providers, converged and antiquated systems and an increased staff, the respected facility, while increasing its capacity to serve, began to struggle in some of their operational processes, particularly in the area of revenue cycle. Rosecrance’s Chief Financial Officer, John Schuster, characterized this transitional time as a “perfect storm” of disparate challenges that came together, causing some significant interruptions in connection with their revenue flow. Combined with the complexities of filing Medicaid billing for the state of Illinois, John indicated during this stormy time that the organization was leaving millions of dollars on the table in unbilled services. They needed help fast, and it came in the way of a vital collaboration with RSM consultants.
John had known an RSM professional from a previous health care industry relationship and began visiting with him about his current revenue cycle worries. Soon, a team was pulled together to analyze critical issues. The RSM consultants performed a Rapid Assessment® to understand current revenue flow systems and lapses. After thorough discussions with leadership and staff, along with careful analysis of existing processes, the team provided recommendations to address some of the troubled areas impacting Rosecrance’s revenue cycle. According to the team, immediate areas to focus on included addressing roadblocks and inefficiencies, like the failed Medicaid billing process, implementing updated process flow improvements, training and optimizing technology.
“What I appreciated about the team was their willingness to listen and thoroughly understand our specific issues and challenges,” said John. “I like the fact that they adapted to what we needed, but they were straight shooters, too, with good ideas. They challenged us to make the right improvements for our organization.”
One of the most impressive results from the collaborative efforts between Rosecrance and the RSM team resulted in recovering nearly $9 million from pre-existing, unbilled Medicaid disbursements. Due to process inefficiencies and state-based software issues, Rosecrance had not billed Medicaid for nearly six months. After new processes and system upgrades were put in place, the organization was able to rebill with success and continues to do so. Other outcomes included:
- Implementation of efficient processes through the entire revenue cycle, including front-end, middle and back-end systems
- Improved accuracy of collected data and reduction of denials
- Standardized workflows and automated key functions and controls
- Process improvements across the organization, including communication streams
- Change and behavioral management improvement through ongoing staff training
- Implementation of business analytics to improve reporting and accountability
- Data analysis and continuous improvement functionality