RTech Case Studies

Five Hospital Health System –Speed to Results
Internal Revenue Teams and a Major Revenue Cycle Initiative
Charge Discovery -Implantables and a System Error
System Changes and Trust
Process & Systems, Speed to Results and Outside Agencies
New Client System Conversion
Assisting with Data/information
The Internal “Sweep”
Excellent Internal Software Tools

RTech earned the opportunity late in the calendar year to assist a five hospital health system with uncovering new revenue and cash and to avoid any potential time-barred claims before December 31^st. We discussed the engagement via conference call, agreed to sign business associate agreements and in the last week of November, received the data for the five hospitals.

RTech loaded and tested the data immediately and initiated our logic based software to uncover billable insurance accounts. Using our high speed payor validation software, our team of Analysts went to work being absolutely certain that our findings were billable and that the client was not working or aware of what we had uncovered. Within 14 days, we submitted our results to the client! They began billing and were able to complete it prior to December 31^st, thus avoiding any time-barred claims. New revenue and cash saved by RTech. Today, we still enjoy a valuable and trusted relationship with that client and continue to identify new revenue and cash for them.

At one of our largest health systems we routinely identify process and technology issues for senior management. That is what they expect. And, the added revenue and cash is a plus. They use the RTech service correctly.

One key factor is that this organization has two internal revenue discovery teams that target a wide range of opportunities. In most areas, RTech works behind their efforts after they perform their work. Of course, RTech’s logic based software is far more developed than what clients and other firms use, enabling us to generate additional results after someone else’s best effort.

For approximately 18 months, this client engaged a known and reputable revenue cycle consulting firm to accelerate cash and “discover” revenue. We were more useful than ever to this client during this engagement. You see, management implemented the company’s A/R tracking systems and focused on higher thresholds of collections. Millions of dollars of “less than $1,000” accounts were ignored . RTech drove more revenue than we typically did for this client during that period. And, because we shared our results and knowledge with the client, they were able to provide solutions to avoid the missed revenue and cash going forward. The key point- RTech can provide great value even when you engage internal and external revenue discovery resources.

We presented an automated approach to uncovering missed surgical implants for a university based teaching hospital and a long-time client. Given their large managed care patient population, their contracts include separate “pass-through” payments for implantables.

RTech, using proprietary software and an experienced nurse professional with extensive charge capture experience, found hundreds of implants that were not only unbilled but the charges never made it to the patient’s accounts. After field validation of medical documentation, the client initiated billing to the third party payors, topping $2 million in new revenue and cash. RTech discovered that the source of the opportunity was a system interface breakdown during a specific period of time that was unknown to the client. This is how RTech’s discovery approach helps our clients identify revenue cycle areas of process breakdowns and knowledge to close the gaps.

One of our longstanding clients had been making numerous modifications to their registration and billing systems. Since RTech obtains monthly data re-freshes from the client, we spotted a significant trend of missing revenue in a specific area. Based on findings from our logic based software tools, we diagnosed the source of the issue and determined that it totaled approximately $900,000. We attempted to meet with the client for several months but they weren’t focused on the issue. Once they did, and we presented our findings, they agreed to proceed with remediation. Both IT and Finance management greatly appreciated our support and realized the value of RTech’s monthly Sweeps. They would have continued to lose revenue and cash for many months had we not uncovered it. What clients appreciate about us is that our professionals are expert in both healthcare IT and Revenue Cycle and provide value “Beyond the Numbers”

We recently re-gained a client that had been financially distressed for some time. After several changes in management and use of outside consulting firms, they provided RTech with a data extract. Within weeks, we presented them with close to $3 million in opportunities. Several months earlier, they had sent a substantial volume of accounts to a national agency. After 3 to 4 months, the agency could not identify correct insurance information for any of the accounts that RTech uncovered in three weeks!

Another long-standing client recently experienced an enterprise-wide conversion to a new system vendor. Not surprisingly, the installation did not go as planned and cash flow began to significantly decrease.. The first thing RTech assisted with was “scrubbing” the old system data to make sure that nothing was missed that would ultimately time-bar and be lost forever. Then we obtained a complete data set from the new system for the first six months after the implementation and began the RTech advanced revenue discovery process. We uncovered a number of system set up issues that the client was able to immediately correct through the vendor and made them aware of areas where they needed to improve process and training to avoid costly losses of revenue and cash. They look to RTech to diagnose and share the knowledge. They trusted that RTech would not take advantage of them at such a vulnerable time. During the system conversion we gave the client , quick knowledge and quick corrections…again, value “Beyond the Numbers”

RTech has always made a commitment to our clients that if a special analysis report is needed, we would provide that at no added fee. A teaching hospital that completed a rapid system implementation had received notification from its rate setting commission that there was a significant error in reported discharges and days. Unfortunately, they did not have easy access to their previous system since it was operated by a previous alliance group’s IT shop and the relationship had severed. They called RTech, knowing that we not only have their detailed historical transaction data but are expert in developing software that can extract information from any database. We quickly produced the reports that the client needed to satisfy the rate commission and alleviate a substantial adjustment to their prospective payment rates. Again, another example of the RTech focus on client service and value. If we can help we will find a way to make it happen, often at no additional cost.

As we have made clear, our approach works regardless of what internal or external resources are being used by a client. This particular client has internal software that can perform certain “Sweeps” of Medicaid patients, to identify missed insurance information. We consistently have to wait until this “Sweep” is performed before we can obtain their data and deploy the RTech advanced discovery tools. Regardless of what the client did, RTech repeatedly identified in excess of $400, 000 of new revenue and cash each and every cycle. Given that we have invested over ten years of software development, are expert in registration and billing systems and know their strengths and weaknesses, are an all payor , all services discovery company we always identify opportunity. We fully expect our clients to find as much as they can and then let us perform. That is why they use us year after year. While some of the client staff are frustrated by our work, those in financial leadership understand that they can continue to improve with the knowledge we provide.

For over seven years, we have served this 1000 bed teaching hospital with approximately two million ambulatory encounters that has a reputation for developing and using internally developed discovery software. They invest substantial capital and resources and are trying to move the discovery process to the next level. Despite all of their internal efforts, they welcome RTech on a periodic basis to “drop in” behind their internal cycle to identify what they may have missed. In the most recent sweep, RTech uncovered $450,000 in added revenue and cash . This is a professionally challenging experience for our people but a rewarding one when we uncover opportunity and add to the client’s knowledge base.