19organizations face obstacles when requesting reimbursements because they are tied to patient satisfaction, higher patient responsibility because of deductibles, evolving payment methodologies, and the shift to value-based care.A unique formula to combat disruptorsTo address this issue, Nicklaus Children's has partnered with a revenue cycle management company to develop a unique formula to successfully combat these disruptors. Over the last months, we've taken a very close look at our operations and finances and started to implement multiple tools that help us drive financial performance. With such a significant reliance on Medicaid, we had to optimize our revenue cycle process and that work began in late 2019 and early 2020, just before the pandemic began. Thankfully for us, this pre-pandemic work allowed us to be better positioned to face the challenges from the pandemic. Together with our revenue cycle management partner, we implemented best practices in revenue cycle across the organization, including:· Charge reconciliation process and policy;· Revenue integrity opportunities identified throughout;· CDM assessment: currently partnering together through strategic pricing review;· Managed care escalations: no JOCs prior to our engagement with the revenue cycle management partner.An optimized and improved revenue cycleAs a result of our work, we achieved an optimized and improved revenue cycle. We increased our cash and POS collections, reduced the denial rate and unbilled AR days, and we are reinvesting the underpayments we recovered into patient care and patient service. That means we can continue to focus on our mission of providing the best care to every child. It allows us to continue our efforts to listen to our community, the children, and families who rely on us for medical support. We have been honored to serve our community throughout the pandemic, providing for the clinical needs of children and families in an adapted environment to ensure the safety of those we serve. Being in a financially stable position ensures we will be able to do just that for years to come.
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