Case Studies

Major Medical Center Reduces Days to RAP by 75% and Days to Claim by 50%, Eliminates Medicare Denials at Home Care Operation

A major medical center in the Southwest outsourced to CareSouth the back office functions of its $8.5 million home care operation. They sought improvements in revenue cycle processes from intake through billing and collections, including clinical review of OASIS and plan of care documentation.

Prior to the conversion of the agency to the CareSouth information system, days to Request for Anticipated Payment (RAP) averaged 35. Within three months, CareSouth reduced those days by 45% to an average of 19. After one year, the agency not only sustained the improvement but also decreased further to 9 days to RAP - an overall improvement of 75%.

The agency also struggled with submission of final claims with an average of a 50-day lag time from the end of the episode to final bill. Currently, final claims are submitted within 25 days - a 50% reduction with CareSouth information systems.

The CareSouth Utilization Management department helped the agency assess the quality of OASIS and plan of care documentation, appropriateness of services and accuracy of HHRG. Prior to the CareSouth review process, the agency experienced significant HHRG adjustments and downcoding from the fiscal intermediary and lost 4% of its Medicare revenue due to denials. In the second quarter of 2002, the agency had no downcoding or denials and HHRG adjustments were taken before final claim submission.

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