Thought Leadership

New Vista Success Story – Retooling a Revenue Cycle in Need

The challenge

The mantra of Revenue Cycle Management is as follows: “Bill and Collect the Correct Amount for all Services Provided in a Timely Fashion.”   This seems reasonable, yes? But what happens when it’s not the case?  You believe that the new Electronic Health Record you’ve just implemented should provide this comfort.  But what happens when that’s not the case?

Here’s what can happen: your new EHR is having a difficult time getting bills out the door with almost $3 million of claims stuck in the system, you are months behind in posting payments, finalizing billing processes, and closing the books each month.  When this became reality to the leadership at New Vista, they turned to Afia for help. 

New Vista is a Mental Health and Substance Abuse organization serving almost 20,000 clients across 52 locations throughout 17 counties in Kentucky.  Their leadership was clearly concerned as to whether or not bills were being sent, if they were being paid, and if they were receiving the apportioned amount for each service provided. 

Staff reported they felt as though they were “wearing blinders” because they didn’t feel they had the training or information needed to fix the problems.  

The engagement

Based on the number of issues New Vista was experiencing, we knew that we were going to have to start with a deep dive into New Vista’s workflows, data capture methodology, and EHR setup to identify the root cause of the problems. As a first step, we went directly to the source and met with the billing and finance staff. During this phase of the project, we worked together to identify where information was being captured, how the system was configured, and how the files were being processed. We created reports and extracted data to understand any data integrity issues that were causing systemic problems. 

Utilizing this information, we were able to identify updates that needed to be made to both the EHR and New Vista’s workflows to prevent the issues from reoccurring, and to ensure bills would go out the door. As we were working with staff, we also tried to understand the pain points, because it became apparent that they had limited comfort with the functionality of the system.

New Vista also seized the opportunity to step back and have Afia assess their entire revenue cycle;  from the time a patient seeks services with the organization to the time they close the books at month-end.  Unless every process on that revenue cycle “wheel” is functioning properly, the organization cannot be assured it is billing and collecting the correct amount for all services they provide.  That assessment helped identify inefficient, ineffective and/or redundant processes, opportunities to optimize its use of the EHR, and organization structural changes that could improve accountability and accuracy of the critical steps that have to be in place before a bill ever goes out the door.

The outcome

New Vista CFO, Dana Royse boasts “as a result of our work with Afia, our bad debt rate had dropped from 8% to 2.9%, our lowest rate in twenty years!  That reduction translated into an increase in revenue of approximately $2.0 million per year!” 

Royse also states,  “we are now collecting 97% of Medicaid Claims, which is our largest payor, within 30 days. So, not only did cash flow improve with a corresponding decrease in days in accounts receivable, the billing staff could touch and feel the positive impact of their efforts and the changes that had been made in their processes and use of the EHR.  Employee morale was at an all-time high as a result.”

All Thought Leadership