GAINESVILLE, Va.--(BUSINESS WIRE)--Convergent Revenue Cycle Management, Inc., leading provider of healthcare revenue cycle management and patient access solutions to top healthcare providers across the nation, announces a new case study on workers’ compensation and third-party claims follow-up with Community Medical Centers, a three-hospital system in Fresno, Calif. The study was conducted by the Healthcare Business Insights, an organization specializing in providing hospitals with objective research to strategically drive initiatives that improve financial health and patient satisfaction levels. The case study outlines, like many hospitals, Community did not have the resources or legal expertise to manage workers’ compensation claims cost effectively. To resolve these claims, Community looked for a trusted partner to help maximize reimbursement from third-party payers, selecting Convergent. The revenue cycle case study reveals the methodology Convergent followed to collect $35.9 million in workers’ compensation and aged insurance accounts, adding revenue to Community’s bottom line.
“Our success at partnering with top performing providers is founded on our ability to quickly and effectively increase reimbursement for healthcare services with the appropriate resources and adherence to regulatory requirements”
Community relied on Convergent’s healthcare attorneys to navigate complex California reimbursement regulations and increase collections. “We were initially looking for someone to do all of the workers’ comp. follow-up that had the ability to take it all the way to legal pursuit,” said Michelle Earnhart, Corporate Director of Patient Financial Services at Community. “That was one of the reasons Convergent was chosen: because they had a complement of attorneys that could follow up on the California workers’ compensation.”
From Community’s perspective, the follow-up process for workers’ compensation in the new workflow is relatively straightforward. “What we do is manage the referrals,” Earnhart says. “We reconcile the accounts—the volumes and the dollars that are sent and sent back—we monitor the cash collections and really that is all we do.”
Convergent handles all of the traditionally difficult tasks associated with workers’ compensation follow-up. Working directly from Community’s HIS system, the national revenue cycle management firm used its own technology to calculate the expected reimbursement based on California’s complex fee schedules, comparing actual payments and identifying underpaid claims. Whenever an underpayment is identified, Convergent provides the appropriate follow-up through phone calls, letters, and litigation if necessary.
“Our success at partnering with top performing providers is founded on our ability to quickly and effectively increase reimbursement for healthcare services with the appropriate resources and adherence to regulatory requirements,” said Derek Pickell, CEO of Convergent Revenue Cycle Management.
Founded in 1992, Convergent’s healthcare division serves hundreds of hospitals and healthcare providers across the nation. Their regulatory expertise and patient-focused contact center technology optimize revenue cycle performance, enhances the patient experience, and improves provider relationships.
To access the case study, visit www.convergentusa.com/library.
About Convergent Revenue Cycle Management, Inc.
Convergent Revenue Cycle Management is recognized as the premier niche revenue cycle management company in healthcare, providing innovative solutions across the revenue cycle spectrum including patient access solutions, early out self-pay collections, attorney-powered third party reimbursement and bad debt recovery (through Convergent Healthcare Recoveries, Inc.). Our regulatory expertise and consumer focused patient contact center technology optimize revenue cycle performance and improve healthcare provider relationships with patients and physicians. The healthcare division has operation centers in Virginia, Texas, New York, Florida, and Illinois.
About Convergent Resources, Inc. (CRI)
Headquartered in Atlanta, CRI is one of America’s largest revenue cycle, receivables and customer care management companies with thirteen operating centers across four time zones. The company provides healthcare revenue cycle management, consumer contact outsourcing services and commercial receivables management to a variety of healthcare providers, utilities, telecom companies, financial institutions and others.