Client Case Studies:

Read recent examples of how we have helped our clients resolve complex business issues and achieve high financial and operational performance

Acute Care and Rehabilitation Hospital

Description: Stand-alone 46-bed level 4 hospital providing detox, residential, IOP and routine outpatient treatments.

Issues: The hospital struggled financially, experienced high staff turnover, documentation by clinical staff was inadequate and accounts receivable ballooned with >20% bad debt.

Actions Taken:

  • Assisted in streamlining internal processes to successfully obtain authorizations at appropriate level of care and promptly communicated denial root causes. A dedicated appeals team obtained retro-authorizations and overturned denials.
  • Pursued a diligent appeals process and leveraged relationships at insurance carriers to recover 93% of $400,000 in denials for timely filing.
  • Implemented an effective 3-phase patient collection process with patient statements and convenient payment options, followed by balance-due reminders after 90 days, and last resort collection efforts by partner contingency collection agency.
  • Established a high degree of transparency through bi-weekly calls with the facility’s clinical and finance teams. Detailed analysis and actionable reporting aided in monitoring improvements.

Addiction Treatment Group

Description: In- and outpatient alcohol and drug addiction treatment facility acquired by investment group operating over 50 facilities in multiple states.

Issues: The new facility was inadequately staffed with high employee turnover, its billing system and processes were insufficient to meet payor requirements, and claims were submitted late or missed.

Actions Taken:

  • Assessed process and performance gaps, and developed a roadmap towards clinical and financial excellence
  • An expert SBSC utilization review nurse handled the most difficult appeals and recovered $290,000 in previously denied claims within the first year.
  • Simultaneously, SBSC’s claims resolution specialists scrubbed outstanding claims and refiled or appealed until payment or settlement was reached.
  • Streamlined charge capture process, claims were submitted within 48 hours of patient’s discharge which significantly expedited and enhanced payments.
  • Created custom reports to monitor risks and reliably predict facility revenue