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A Laboratory Client Success Story

Transforming End-to-End Revenue Cycle to Fuel Accelerated Growth

Step into the realm of transformative healthcare solutions with SYNERGEN Health, a trailblazer in revenue cycle management. SYNERGEN Health was engaged by one of the most prestigious academic healthcare systems in the country where they were experiencing challenges with claim follow-up delays and an overwhelming 180+ AR backlog, compounded by repetitive denials.

Recognizing the need for expertise, the healthcare system sought a reputable revenue cycle partner to combat these obstacles and enhance performance metrics visibility. Comprising 11 hospitals and over 425 provider locations, the healthcare system stands tall as one of the largest clinically integrated networks, boasting 3,450+ physicians specializing in 70 different subspecialties.

Witness the impact of SYNERGEN Health’s collaboration and partnership, driving operational excellence and unlocking new possibilities in healthcare management.

“SYNERGEN does a great job in finding trends, which is not something that every vendor offers and is much appreciated. We are finally making progress that results in payments. We appreciate the SYNERGEN team's due diligence and commitment to our business each and every day. They truly are great partners!”

Vice PresidentRevenue Cycle

Identifying the Problem

One of the largest healthcare systems in the U.S. faced escalating labor costs, staff retention issues, and a backlog in receivables. Additionally, transitioning billing systems added complexities, and the lack of visibility into denial trends and key performance metrics made optimizing revenue cycle an uphill battle.

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Escalating Labor Costs & Backlogs:
The facility confronted a critical challenge as labor costs surged, and staff retention became increasingly difficult. This labor-intensive environment led to a mounting backlog in receivables, significantly impacting their revenue cycle efficiency. Moreover, the specific challenge of managing low-dollar value lab claim follow-ups further strained their staffing resources, impeding the timely resolution of claims. These obstacles threatened to hamper the laboratory’s financial success.

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Billing System Transition:
The healthcare system faced a critical juncture during the transition from GE Centricity to Epic Hyperspace. This shift presented substantial staffing challenges in managing legacy accounts receivable. Maintaining uninterrupted cash flow during the system transition and timely winding down of accounts receivable before retiring the older billing system proved complex.

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Aged Receivables & Timely Follow-Ups:
Delays in claim followups created a pressing challenge, leading to a significant increase in aged receivables. The accumulation of aged accounts posed a critical risk of surpassing timely filing limits for follow-ups on older accounts receivable, potentially jeopardizing their revenue stream.

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Lack of Visibility into Denial Trends:
The facility grappled with a significant hindrance in their revenue cycle management – a lack of transparency and visibility into essential key performance indicators (KPIs) and performance metrics. The lack of insights made it arduous to identify denial trends, leaving the laboratory in the dark about crucial revenue-impacting patterns.

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Volume of Denied Claims:
The facility faced a notable upsurge in denied claims, presenting a formidable challenge. The rise in denied claims, coupled with a higher percentage of repetitive denials, put immense strain on the facility’s financial health. Moreover, the complexities of handling Medicare Return to Provider (RTP) claims added further delays, hindering the facility’s ability to achieve optimal revenue realization.

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Revitalizing the Revenue Cycle Process

To successfully transform the revenue cycle process, SYNERGEN Health implemented the following solutions and services:

  • Effective Staff Augmentation:
    Within a short span of 4 weeks, SYNERGEN’s staff augmentation swiftly addressed volume shifts in payments, yielding remarkable results. Additionally, on one project, the enhanced workforce efficiently absorbed over 100,000 additional claims, surpassing the agreed-upon scope and highlighting the efficacy of the streamlined workflow process.
  • Reduced Aged Receivables & Denials:
    SYNERGEN’s intervention led to an impressive 80% reduction of aged receivables beyond 120 days within the first six months. Proactive measures were taken to address root causes for denials at the front end, while system rules were optimized prior to claim submission to minimize denials. Furthermore, by streamlining the Epic workflow we gained further efficiencies, throughput and one-touch fixes.
  • Enhanced Reporting & Analytics:
    SYNERGEN’s powerful reporting and analytics solutions provided invaluable insights. This heightened visibility into denial trends and key performance metrics transformed their revenue cycle management, enabling more informed decisions and optimizing collection efforts. The enhanced clarity became a game-changer for the facility’s financial
    performance.
  • Successful Denial Re-Submission & Appeals:
    The collaborative partnership with SYNERGEN resulted in a commendable 49% success rate in re-submitting previously denied claims and a 33% success rate in winning Medical Record appeals. The actual revenue collected from the project surpassed all expectations, reaching an astounding $10.8M, seven times higher than originally projected.

Reduction of Aged Receivables

$10.8
REVENUE COLLECTED
(7X EXPECTED ROI)

Denied Claims Success Rate