Data-driven analytics revved up revenue cycle of national vision care services organization for improved growth

Challenge

EXL Health in partnership with REVELOHEALTH™, an independent healthcare re-pricing and information solutions provider, was selected to assist a large national vision care management services organization to support their revenue cycle operation through a combination of leadership and staff augmentation. Together they addressed major challenges related to denial management and payment posting that was causing a significant impact to revenue during a critical system conversion.

The work was initiated in August 2022 and by September 2022, the partnership team had determined that the client organization was seriously underperforming in revenue generation and collections due to a lack of data-led analysis, inefficient process design, and inadequate staffing. To grow, the company would need to clear its backlog of outstanding receivables and institute a new, digitally supported revenue cycle management (RCM) program to drive the business forward – with EXL Health executing the plan.

Human Ingenuity

To start, the client’s process workflows for denial management and payment posting were redesigned to address existing gaps, creating a blueprint for clearing the backlog and streamlining the operation. A three-pronged approach to improve performance was deployed:

• Implemented iSTACK™ analytics – Including a robust, updated set of digital tools for ingesting, processing, analyzing, and reporting on data to support decision-making
• Deployed RCM leadership and process redesign – Including 12 operational resources
• Expanded resources – Increasing the team to 27 full-time employees by December 2022

The first wave of reconciliations focused on aged accounts receivable (AR) over 120 days and payment posting backlog issues. The scope has expanded to all payment posting and AR supporting the client’s entire revenue cycle. Concurrently, the team worked with the client to migrate onto one common billing system, effectively consolidating data-led AR collections and posting activities from three central business offices into one.

Outcomes

At present, the client’s RCM has stabilized, generating revenue and improving collections on a variety of fronts: