Health services case study

Healthcare provider regains control of their revenue cycle

 

National healthcare provider gains control of accounts receivable leading a cascade of self-funding improvements in the revenue cycle

Client: Large national healthcare provider
Our Role: PwC accounts receivable (A/R) professionals worked with our client to eliminate the A/R backlog and make systemic revenue cycle improvements.
Results: Collected over $1.5 billion in cash, avoided over $100M in write downs and normalized revenue cycle operations for the client.
Industry: Health Services
Services: Fit for GrowthFinance Transformation, Data and analytics
Solution: Virtual Business Office

 

Situation:

How can our national healthcare provider client regain control of accounts receivable (A/R), reverse negative cash flow and improve the revenue cycle?

Our client is a large national healthcare provider, operating multiple hospitals and serving thousands of patients every month. Following a challenging technology implementation, the client was presented with continuously growing cash shortfalls. A/R days had grown significantly and the client was on the verge of incurring substantial timely filing denials on over $100 million in receivables. They didn't really know why.

Cash had declined, and there were significant process and workflow issues. The client’s legacy system was so old that their productivity measured against industry-standard benchmarks was off by about 50%. All of this, in addition to high attrition, compounded the A/R problem. The healthcare system needed a get well plan very quickly.

 

Solution:

PwC worked with our client to eliminate the A/R backlog and look for opportunities for systemic improvements in the revenue cycle

Our engagement with the client began as a “one time placement” and evolved into a Fit for Growth transformation. Our client initially gave us a portion of their A/R for resolution. We immediately brought in our Virtual Business Office team, a group specifically set up to help clients remediate third-party aged accounts receivable at scale and realize more efficiency from their workforce. Within the first week, the Virtual Business Office performed a detailed analysis of our client’s A/R function and the cash performance across all payers and entities. This yielded insights into why the performance was suboptimal. We found that our client was having significant process and workflow issues associated with not having prioritized their inventory (over a billion dollars). They were also managing A/R with spreadsheets and manual reports. In addition, their staff shortages meant that they never had the bandwidth to get A/R under control. That was about to change.

Resolution QueueTM to the Rescue

Within two weeks, the Virtual Business Office was able to focus 300 trained, experienced A/R professionals on our client’s A/R problem. The Virtual Business Office was connected directly with the client through a VPN and operated as an extension of our client’s workforce, with no need for application integration or file exchanges with IT to slow things down. Within the first few weeks, our client was seeing results. Cash was coming in and things were getting back on track. The portion of A/R that our client’s team was working on started to fall behind again due to staffing issues and the limitations of their old system, so they reached out to ask for more help moving forward.

Since the beginning, we had taken a consultative approach to working with our client. Our team was completely transparent with our client regarding potential system and process improvement opportunities we uncovered during our portion of the A/R work. So when we knew that we’d be helping the client on a longer-term basis, we introduced our proprietary Resolution Queue work-flow tool into our client’s environment as a major upgrade to their process. Resolution Queue gave our client the ability to strategically prioritize accounts for work, enabling the team to focus on accounts that were at risk of untimely filing denials as well as more granular management of their A/R portfolio generally. Resolution Queue also allowed the client to track metrics and provide insight into individual and team performance.

“This started out as an A/R outsourcing engagement but turned into much more. Along the way, we were able to work with the client as a trusted advisor to help them make significant improvements to their revenue cycle.”

Josh CahnPwC Principal

 

Results:

Show me the money: How does $1.5 billion in cash sound?

It’s hard to overestimate the impact an additional 300 highly trained A/R specialists and experienced senior consulting resources can have on an A/R problem. Our client was able to quadruple their staff within two weeks with no additional infrastructure investment and in short order, they were cash flow positive. But it gets better. Working with our team, here’s what the client has achieved to date:

  • Normalized revenue cycle operations, exceeded cash goals and remained cash flow positive every quarter for the past three years.

  • Collected over $1.5 billion in cash for the client since the beginning of the engagement.

  • Avoided significant write-offs (over $100M) due to timely filing denials. 

  • Worked down legacy A/R prior to the cut-over to a new patient accounting system, avoiding a write-down of those receivables. 

Throughout the engagement we have worked with the client as a trusted advisor to connect them with a broader suite of PwC services to help improve their revenue cycle. The client has been able to fund improvements through the cash they collected and has been able to meet their cash goals while the improvements were being implemented.

Larry Patrick

Larry Patrick

‎‎Health Service Operations Leader, PwC US

Joshua Cahn

Joshua Cahn

‎‎Principal, PwC US

Stephen Lutfy

Stephen Lutfy

Managing Director, PwC US

David Thompson

David Thompson

Director, PwC US

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Larry Patrick

Health Service Operations Leader, PwC US