Strengthening Accounts Receivable Integrity and Financial Performance in Healthcare
The Challenge: AR Inaccuracies, Compliance Risk, and Revenue Leakage
A post-acute care organization partnered with Everest Management Solutions to evaluate its Accounts Receivable (AR) performance and revenue cycle management. The organization was experiencing financial inaccuracies, compliance risks, and limited transparency in its billing operations.
Everest’s assessment revealed key challenges:
- $12.68 million in total AR, with $3.7 million in credit balances, significantly understating performance and posing compliance risk.
- Private pay exposure exceeding $3 million, including miscategorized managed care plan (MCP) balances and unbooked patient liabilities.
- Contract set-up and billing system misalignment leading to missed revenue capture opportunities.
- No structured Triple Check process for Medicare and Medicare Advantage claims, increasing billing errors and potential denials.
- Fragmented reporting from the third-party billing partner, with no standardized KPIs or monthly AR reviews.
These deficiencies created operational inefficiencies, compliance exposure, and inconsistent revenue realization across the organization’s portfolio.
Our Approach: Comprehensive AR Remediation and Revenue Cycle Stabilization
Everest implemented a comprehensive AR remediation and revenue cycle stabilization plan, integrating compliance oversight, system correction, and leadership reporting tools to restore accuracy and accountability.
Key actions included:
- Conducting a contract-to-system audit to ensure payer setups and rate tables were aligned with approved contracts.
- Developing standardized AR dashboards and private pay tracking tools to improve visibility and oversight.
- Reinstating a Triple Check process for Medicare and Medicare Advantage claims to strengthen billing accuracy and reduce denials.
- Completing a credit balance clean-up and root cause analysis, resulting in permanent process corrections.
- Implementing real-time patient liability (PL) tracking to improve collections and prevent unbooked balances.
- Establishing monthly revenue cycle KPIs and executive-level reporting to drive accountability and trend management.
This integrated approach aligned operations, finance, and compliance functions to ensure sustained improvement and transparency in AR management.
Results: Measurable Financial Recovery Within 90 Days
Everest’s intervention delivered measurable financial and operational outcomes within 90 days:
- Credit balance exposure of $3.7 million was identified, categorized, and remediated, reducing compliance risk and improving reporting accuracy.
- Private pay exposure exceeding $3 million was validated, corrected, and integrated into active collection processes.
- Billing accuracy and revenue capture improved significantly through contract realignment and process standardization.
- Leadership gained real-time visibility into financial metrics through customized AR and revenue dashboards.
- A Triple Check process was reinstated, improving Medicare billing compliance and reducing risk of denial or audit discrepancies.
These corrective actions resulted in more accurate reporting, better cash flow predictability, and restored compliance confidence with regulatory and payer requirements.
Key Takeaways
- Contract alignment and structured Triple Check protocols are critical to sustaining accurate billing and compliance integrity in healthcare.
- Regular credit balance audits and private pay oversight safeguard organizations from significant financial and regulatory risk.
- Real-time AR dashboards and revenue cycle KPIs empower leadership to manage proactively and maintain long-term financial stability.
Everest Management Solutions partners with healthcare organizations to identify hidden revenue, eliminate inefficiencies, and ensure compliance throughout the billing lifecycle.
Ready to strengthen your AR integrity and boost financial performance? Contact [email protected] to learn how Everest’s Revenue Cycle Optimization services can help your organization recover revenue and restore control.
Client names and identifying details have been omitted to maintain confidentiality.