Large Hospice Revenue Cycle Turnaround

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Client Profile:

As one of the largest not-for-profit hospices in the Mid-Atlantic, this client provides inpatient, home care, and respite hospice services to over 750 patients each day.


The hospice experienced significant and sudden turnover in its revenue cycle operations and leadership resulting in an increase in accounts receivable of more than 50%, significantly increased write-offs for timely filing and "no-authorization" denials, and a corresponding significant reduction in cash collections..

Working in an interim leadership capacity, i3 rapidly assessed the tools and systems, staff and management, operational processes with an initial focus on Medicare (representing 85% of its patient volume). We specifically assessed the hospice's ability to meet CMS' five-day requirement for completing all related patient election, assessment and admission documentation (81As). We later assessed their ability to meet the pre-authorization, billing and follow-up/collections for Medicaid and commercial payers. As a result of the assessment hospice executives authorized the implementation of improvements including:

  • Reorganizing revenue cycle operations to establish dedicated payer billing and collection teams, supported the recruiting and hiring of staff and transitioning department leadership to a new revenue cycle leader
  • Expanding and retraining authorization staff and establishing improved coordination and communication with admissions and clinical teams responsible for evaluating and managing the admission of each hospice patient
  • Optimizing existing tools and Cerner systems in place to increase efficiency and effectiveness of revenue cycle staff, with a focus on training and establishing of standards and expectations.
  • Establishing an appropriate outsourcing strategy and partnerships to support collection of aged commercial accounts and processing of Medicaid pending accounts.

Some of the results from the first nine months of this project, including assessment time, are:

  • Increased average monthly cash collections by $1.1M or 30%
  • Reduced billed net AR by 38% 
  • Reduced unbilled net AR by 50%
  • Reduced write-offs for no authorization or timely filing by 80%
  • Reduced Return to Provider (RTPs) accounts and dollars by approximately 75%
  • Expanded electronic billing to include an additional six payers reducing the number of monthly paper claims by approximately 70%