Accelerating Cash Flow and Business Office Efficiency

“We're always looking to save the institution money, be more effeicient, bring our accounts recievable days down, and to use technology to make those things happen.”

-  Linda Morris
Director of the Nanticoke Health Services business office


Nanticoke Health Services
Seaford, DE


Improving business office efficiency while providing more patient-centered care. 


Assurance Reimbursement Management™
Clearance Patient Access Suite


  • Accelerated cash flow by $1 million within 30 days
  • Transitioned from two full-time billers to five staff members trained on all aspects of working a claim
  • Approaching 12% reduction in AR days
  • Established KPI of 5 minutes or less patient time from registration to next service area

The Customer:

No stranger to leveraging technology in pursuit of improved business operations and clinical care, Nanticoke Health Services (NHS) earned “Most Wired” recognition from Hospitals & Health Networks in 2015 and 2016. The comprehensive care system, consisting of 99-bed Nanticoke Memorial Hospital (NMH) and a network of 40 employed physicians and providers, continues its quest for excellence grounded in healthcare’s Triple Aim of enhancing population health services, maximizing care quality and patient experience, and lowering costs. NMH was the first hospital in Delaware to receive a 4-star rating from the Centers for Medicare and Medicaid Services, and continues to hold that rating today.

The Challenge: Improving Operational Efficiencies

NHS is one of four Delaware health systems participating in eBrightHealth ACO, a Medicare Shared Savings Program accountable care organization. While the affiliated ACO providers work in concert with Medicare to deliver better, more coordinated service and care to patients, it’s also in its financial interest to continuously explore ways to improve operational efficiencies.

“We’re always looking to save the institution money, be more efficient, bring our accounts receivable days down, and to use technology to make those things happen,” says Linda Morris, Director of the NHS business office.

Morris and her staff of 14 knew that automating revenue cycle management could help in a number of areas: creating custom claim edits to satisfy payer requests; gaining at-a-glance dashboard access to remittance status to determine the reasons behind denied or rejected claims; and helping to generate cleaner claims that contributed to many payments received within 30 days.

Because NHS serves a retirement-friendly community near the Atlantic coastline, the health system needed to prepare for a future influx of Medicareeligible patients with the ability to do Medicare direct entry billing (MDE). NHS expects Medicare to account for a rising share of its payer mix above the current 68% level.


The Solution: Automating Revenue Cycle Management

NHS selected the Change Healthcare Assurance Reimbursement Management™ claims and remittance management solution at the start of 2015 and went live about six months later. The product not only proactively monitors changing payer business rules, implementing updates four times per week (prior to effective dates more than 99% of the time), but also allows the NHS business staff to easily build their own edits.

On the patient access front, NHS chose Clearance Patient Access Suite to help financially clear patients at registration and help collect payments as early in the revenue cycle as possible. Additionally, NHS selected Clearance QA to help improve data accuracy at registration and help reduce claim denials and rework that impede reimbursement. Clearance Lobby, which electronically tracks patient wait times and identifies bottlenecks in service delivery areas, went live in the fall of 2015.

The Result: Accelerating Cash Flow and Reducing A/R Days

The most immediate and tangible advantage of implementing Assurance Reimbursement Management™, according to Morris, was a “quantifiable difference of $1 million in cash flow realized within the first 30 days.” The system helped reduce Medicare return-to-provider (RTP) claims from a level of five to seven per day to approximately one every other day, according to Morris. Assurance Reimbursement Management reduces the need to track down the responsible staff member for further discussion by categorizing RTP claims by status code.

Another key benefit realized by NHS was retaining the ability to build custom “bridge routines,” which satisfy specific requests from individual payers. Two NHS team members have learned to enter bridge routines, which help to proactively drive clean claims without billing department follow-up.

Morris gives high marks to the system for its overall user-friendliness. The health system formerly employed two full-time billers in the business office, but after training on the new technology, billing responsibilities were reallocated to five existing staff members. This year, the number of trained staffers is expected to expand to seven. They are expected to be able to cover for one another on all aspects of sending and billing claims, working edits, and processing claims out of the hospital.

When NHS started with Assurance Reimbursement Management™, its accounts receivable (A/R) averaged about 40 days. That number dropped to 37 shortly after going live, and the health system’s goal of 35 days appears to be within reach, which, when accomplished, would constitute an AR days reduction of more than 12%.

Amie Phulesar, NHS Director of registration, credits the QA product with driving added efficiencies in her area, which has taken over responsibility for outpatient coding. “Registration’s due diligence identifies any error or potential issue with a bill so that we can fix it before it gets to the claims system,” she explains. “Our goal is to not have the billers look at the claim at all.”

Phulesar adds that Clearance Lobby provides for paperless patient sign-in and then tracks patient flow and wait times. NHS aims to establish a key performance indicator of five minutes or less from registration to the next service area.

“With Assurance Reimbursement Management™, there was a quantifiable difference of $1 million in cash flow realized within the first 30 days.”

-  Linda Morris
Director of the Nanticoke Health Services business office

More to Come

NHS expects further gains to accrue once the Clearance Authorization and Clearance Estimator modules have gone live.

“It’s going to be amazing not to have to go to every [payer] website to check for authorizations,” predicts Phulesar. “That information will come back into Clearance and give us the CPT codes and the authorization number if it’s on file. You can’t put a price tag on that efficiency.”

Also, the business office currently provides estimates for MRIs and CT scans; however, those functions will move to registration in the next fiscal year. The transition will help enable collection of payments earlier in the revenue cycle workflow. Moreover, NHS expects accurate estimates to help improve cost transparency while engaging patients — with no surprise bills to follow on the back end of the process. That, in turn, should improve patient satisfaction and help advance NHS’ mission of positively impacting quality of life in its community.

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