Case Studies

Consolidating core revenue functions led to increased cashflow, reduced denials, and overall reduction in total days in A/R

St. John’s Episcopal Hospital

The challenge

Health Care billing systems are designed to register patients, capture insurance information, charges, and coding data to generate billing.

These core systems lack the sophistication to leverage new technology and external data sources into the revenue cycle workflow.

Jzanus provides that technology. St. John’s Episcopal Hospital was burdened by the need for numerous touch points with limited integration between their disparate systems.

Lacking the technology to automate repetitious, low-value, high-volume transactions with limited manpower the challenge for revenue cycle leaders is to work account data more intelligently.

Delivering real–time analytics enables providers to identify and respond to payer denial trends and mitigate the impact on cash flow.

For SJEH and other institutions, this translates into inefficient workflow processes and increased denials. While major advancements in Robotic Process Automation (RPA) and Artificial Intelligence (AI) are used in healthcare in the clinical space, and by insurance carriers generating targeted denials, providers are confronted with outdated technology.

The pain points for St. John’s Episcopal Hospital

  • Workflow heavily reliant on manually driven receivable processes that are prone to human error and staff burnout, increasing denials and disturbances to cash flow
  • Managing high outpatient volumes of low-dollar receivables with a limited staff
  • Inability to access external data sources onto one unified platform with an interactive dashboard to track and analyze financial health and staff performance and accountability
  • Static work queues are unable to intelligently drive accounts to the next actionable step in the payment cycle
  • Inability to determine the root cause for denied services

SMARTWorks Solution has enabled the centralization of our core revenue cycle activities. System Dashboards provide tracking, quantification, and resolution of billing and follow-up activities, expanded insurance discovery, and accountability for all DNFB and Denials activity resulting in increased cash flow.

Brenda Batista, MSBML, CPC Vice President, Revenue Cycle Management

The SMARTWorks transformation

SMARTWorks Solution is a single platform that compiles information from multiple sources, including the host accounting system and the claim scrubber, along with information from 276/277, 837/835 data and insurance carrier websites, and transforms the data into actionable tasks.

By embracing our business intelligence and adopting the benefits of task automation that are core to SMARTWorks, SJEH saw improvements to their financials as well as satisfaction among leadership and staff. SMARTWorks’ availability as a Software-As-A-Service (SAAS) offering means that training, integration, and maintenance are all inclusive of one monthly licensing fee requiring NO capital expenditures, add-on costs, or long-term commitment.

Reviewing the results

The SMARTWorks difference

  • Unnecessary tasks were eliminated from the end user’s queue, including website searches, follow-up on paid claims, and telephone calls to carriers. As a result, the St John’s team was able to use their time to complete the tasks that drive in cash.
  • The automated SMARTDollars insurance verification process re-verifies insurance eligibility in the DNFB step confirming that the linked insurance is eligible for the date of service. If there is an insurance change or a demographic error, the account is updated prior to billing.
  • SMARTClaims, powered by RPA, extracts claim status from payer websites in real time. This, combined with 835 and 277 data, and a mature rules engine, enables the St John’s team to focus on high-value touches and more effectively manage denials.
  • Our Appeals module provides appeal letter templates that can be customized for any denial reason, are stored in our system as a PDF document and are attached to a Due Date tracker for timely follow-up with the carrier.
  • Ineffective interdepartmental email-based communication was replaced with task routing to the appropriate stakeholder within the SMARTWorks tool, improving accountability and productivity monitoring.
  • SMARTWorks provides interactive dashboards to St John’s leadership team allowing superior, customizable reporting and analytics, facilitating agile communication across all levels of the organization.

The results

Increase in outpatient cash collections
even as volume decreased by 5% over the previous year
Reduction in eligibility denials
Reduction in days in AR