Now more than ever, it is crucial that healthcare providers' strategic revenue cycle investments meet organizational needs and help ensure financial stability.
This is what Denver-based CarePoint Health strived for when the organization merged with Emergency Physicians Integrated Care in 2018 to form one of the nation's largest privately held and physician-owned practices. The multispecialty physician group, which employs more than 700 providers in 28 states, partnered with revenue cycle provider R1 RCM to sustain strong financial performance and obtain the expertise needed to support a significantly larger organization with eight vastly different service lines.
During an April 21 webinar hosted by Becker's Hospital Review and sponsored by R1, presenters discussed the partnership and four elements that made it successful.
Presenters were:
- Mark Kozlowski, MD, COO of CarePoint Health
- Dan Pope, senior vice president and general manager, R1
1. Refinement of RCM fundamentals — billing and collections. R1's approach to assisting CarePoint Health was twofold – first, the organization focused on perfecting revenue cycle basics such as billing and collections. The physician group had several problem areas, including excessive claim denials, inconsistent/outdated payer contracts, ineffective accounts receivable follow-up, and overall payment delays. Mr. Pope and Dr. Kozlowski said R1 was able to update physician fee schedules to match market rates, leading to a 20 percent increase in patient collections for the emergency medicine division and an 18 percent increase in patient collections for the pediatric emergency medicine division within six months. R1 also deployed automated rules engine technology that examined claims for accuracy and completeness, correcting any errors to prior to submission. As a result, CarePoint Health reduced claim errors from 8.3 percent to 3.5 percent.
"I think our results establish the effectiveness of the two-pronged approach we took," said Mr. Pope. "Let's get in. Let's fix the basics. Let's get some quick wins. And then let's work on establishing a long-term plan going forward."
2. Standardization and scale to support multiple locations. The second part of R1's approach included identifying opportunities to effectively deliver long-term care enhancements and receive reimbursement for services across CarePoint Health's business. For example, R1 began with CarePoint Health's neurosurgery and Blue Sky Neurology groups to provide a coding education program that had a tailored curriculum which addressed recurring errors in reporting specialized procedures and documenting medical necessity. Mr. Pope and Dr. Kozlowski said the program established much needed trust between CarePoint Health's physicians and coding team members which created more confidence in overall claims accuracy. R1 will continue to expand the coding education program to other CarePoint Health service lines in the months to come.
3. Expertise and technology to address process efficiencies and create lasting enhancements. Leveraging a combination of technology and subject matter expertise from R1 enabled CarePoint Health to strengthen overall operations and evaluate performance more effectively. One example is how R1 utilized analytics to manage performance metrics across CarePoint Health's 41 emergency departments. This technology provided key insights on physician productivity, and produced reports that summarized revenue cycle performance all the way down to the site and provider level. Mr. Pope and Dr. Kozlowski said this real-time performance data allowed CarePoint Health to visualize performance metrics for any time period and eliminated the previous wait for outdated monthly reports.
4. Agility to face unprecedented problems and make immediate changes. The COVID-19 pandemic prompted CarePoint Health to adjust operations amid changing economic circumstances. "We had to react to significant changes in volume and loss in revenue," said Dr. Kozlowski. "At this time last year, our concerns were really centered around viability. We also saw a significant increase in the number of uninsured patients, with people losing work and health insurance. Through it all, CarePoint Health was able to rely on R1 for support and to remain agile."
The physician group extended its telehealth offering for its outpatient neurology business within weeks, and the telestroke program transitioned from stipend-based to fee-for-service reimbursement to generate increased revenue. From March 2020 to March 2021, the outpatient neurology division supported 16,500 telehealth visits and had $2 million in telehealth collections for 2020.
As a result of CarePoint Health's partnership with R1, the organization was able to achieve an overall 20 percent increase in revenue. Dr. Kozlowski also emphasized that CarePoint Health does not have to worry as much about day-to-day RCM tactics anymore and can focus on more strategic priorities such as business growth and development.
To learn more about R1's revenue cycle approach and how they can transform both patient experience and financial performance for healthcare providers, click here.