Revenue Cycle Solutions Payment Integrity Compass Don’t Let Revenue Leaks Drain Your Margins Payers are tightening reimbursement and passing on the pain of reform to providers, via tougher negotiations and complex contract terms, increased denials, and even underpaying signed contracts. We call this revenue leakage. The slow loss of contract value seems insignificant at first, but adds up to a major drain on margins. In fact, the average facility loses 5% of its annual revenue to preventable revenue leakage. But best-practice institutions are making million-dollar gains by optimizing contract negotiations, overcoming denials, and recovering underpayments. © 2013 The Advisory Board Company • advisory.com • 26714 Learn more about reducing revenue leaks and expanding your margins advisory.com/pic Overcoming Denials Recovering Underpayments Case Study: Key Medical Center * Key is a 650-bed hospital in the Northeast that experienced lost revenue due to a siloed system, reporting challenges, and poor workflow. Case Study: Wells Hospital * Wells is a 300-bed hospital in the Midwest that was unable to quantify an anecdotal underpayment problem. Results RECOVERED IN THE FIRST EIGHT MONTHS OF USE DENIED ACCOUNTS OVERTURNED $4.1M 324 Actions Tracking and reporting of all denials in a single comprehensive system Custom denials report Auto-generated, prioritized worklists Actions Display of true gap between expected and actual payment Identification of all payment defects and elimination of false positives Bulk appeals capability to recover high-volume, low-dollar variances Results Underpayment Recoveries RECOVERED YEARLY $1M+ $1.1M YEAR ONE $1.8M YEAR FOUR $1.8M YEAR THREE $1.5M YEAR TWO Case Study: Rogers Health * Rogers is a two-hospital, 800-bed system in the Southwest. Unbeknownst to it, provisions in commercial payer contracts prevented fair reimbursement in outpatient cases. Optimizing Contract Negotiations Results Net Revenue, Large Commercial Payer INCREASE 7.4% $35.0M BEFORE $37.6M AFTER Actions Data-informed negotiation prep Real-time impact modeling of proposed terms One-click charge adjustment * Pseudonymed institution.