Mountains Community Hospital is an 18-bed critical access hospital (CAH) with a nursing home located in Lake Arrowhead, California.

Situation

Mountains Community Hospital was a CAH without a denials management process, which led to an alarmingly high outstanding accounts receivable. Many of their high-volume payor denials were not ever being adjudicated or appealed, and the denials management software had been installed but was not set up for use, nor had staff been trained on its use and reporting capabilities.

Strategy

The goal of Wipfli’s denials management assessment was to identify areas with high potential for improvement that would result in a significant reduction in denied accounts receivable. We assisted the hospital in:     

• Setting up a DSG denials management module.
• Establishing a standardized reporting system.
• Creating standards for all staff work processes.  
• Establishing a multidisciplinary denials resolution team.
• Providing staff education for payor-specific denial adjudication.
• Creating tools and policies to document roles and responsibilities. 

Benefits

With the appropriate tools, procedural knowledge, and timely and accurate financial information, Mountains Community Hospital was given the ability to operate more effectively with more profitability. The hospital:

• Reduced its accounts receivable balance by nearly 80 percent within one year.
• Have seen an increase of approximately $150,000 a month in cash that can be directly attributed to this process.
• Received accurate reporting to equip management with quality information.