St. Luke’s: 76% Denial Reduction Case Study
- Luke’s Health System, processes over 450,000 claims monthly, serving more than 3 million outpatients annually.
- Jake Reid, senior director of Revenue Cycle Business Offices at St.Luke’s, noted the increasing strain on their accounts receivable.
- Luke’s chose Enhanced Claim Status to automate and streamline claims follow-up.
St.Luke’s Health System slashed claim denials by a remarkable 76% wiht Enhanced Claim Status, streamlining their revenue cycle management. This decisive shift addressed the challenges of rising patient volumes and billing complexities, considerably improving efficiency. By automating claims follow-up and pulling data directly from payer sites, St. Luke’s saw “Discharged/not billed” accounts decrease substantially. This strategic automation saved the equivalent of three full-time staff positions annually, enhancing overall financial performance. Discover how News directory 3 can help yoru healthcare organization! Learn more about these advancements.
St. Luke’s Health System Improves Revenue Cycle Management with Enhanced Claim Status
Idaho’s largest health care provider, St. Luke’s Health System, processes over 450,000 claims monthly, serving more than 3 million outpatients annually. To maintain billing efficiency amid rising patient numbers, St. Luke’s implemented Enhanced Claim Status to streamline their claims management process.
Jake Reid, senior director of Revenue Cycle Business Offices at St.Luke’s, noted the increasing strain on their accounts receivable. The health system needed a scalable solution to manage claims follow-ups without increasing staff or affecting patient care. The goal was to improve post-claim follow-up,handle growing account volumes,avoid unneeded work,and accelerate accounts receivable recovery to improve cash flow.
After considering various options, St. Luke’s chose Enhanced Claim Status to automate and streamline claims follow-up. The tool retrieves adjudication data directly from payer sites, providing detailed claim statuses within Epic. This eliminated the need for manual tracking through payer portals.
The system provides real-time insights into denied,rejected,and pending claims,enabling staff to prioritize and resolve issues faster.Claims are automatically routed into work queues based on customized rules,speeding up follow-up by one to two weeks. This allows staff to focus on critical accounts and reduces unnecessary tasks, improving the overall revenue cycle management.
“Enhanced Claim Status will provide you with more details extracted directly from the payer site that you will not get in a regular claim status,” Reid said.
The richer data includes proprietary reason codes and actionable explanations for each claim. st. luke’s collaborated with Experian Health to capture all necessary fields from payer responses and set up support for new payers. They established their own rules for status checks, retry intervals, and cutoff points, categorizing claim status codes to determine the most appropriate work queue.
Outcome
The shift to automated claim status checks significantly reduced administrative work.As 2017, denials dropped from 27% to 6.5%, a 76% reduction. “Discharged/not billed” accounts decreased by $15 million per month. Hospital billing aged over 90 days now consistently meets Epic’s benchmarks, with the watch list down from $13 million to under $1 million since 2019. Patient billing over 90 days is now at 4.5%, placing St. Luke’s among the top performers of epic users.
Automation also saved the equivalent of three full-time staff each year, reducing the overall cost to collect. Staff benefited from better data and more time to focus on complex accounts, increasing their capacity to support patients directly. St. Luke’s successfully accelerated accounts receivable resolution and denials management without overburdening staff, thanks to continuous testing, enhancement, and collaboration.
What’s next
St. Luke’s plans to further refine its use of enhanced Claim Status to optimize workflows and improve patient financial experiences, focusing on continuous improvement and adaptation to evolving healthcare regulations.