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Training and configuration help Texas hospital improve clean claim rates, receive payments quicker

by Goodall-Witcher Hospital Authority

Published on 4/8/2019

After undertaking an initiative to improve their clean claim rate, staff at Goodall-Witcher Hospital Authority (GWHA) in Clifton, Texas helped increase clean claims by 33.79 percent.

Clean claim rates — which represent the percentage of claims leaving an organization’s system that are not returned for revision before they are sent to payers — impact how quickly organizations receive reimbursement from payers, including insurance companies.

“Cerner consultants brought items to our attention that could be improved,” said Rachel Parker, patient finance coordinator. “I reviewed that information, met with my leadership, and showed them what was said and how we could prevent those errors from happening. About 90 percent of them stemmed back to patient registration.”

Cerner consultants and Application Management Services associates, who provide support for Cerner solutions on a 24x7x365 basis, worked with Parker to configure claim rules within Cerner Patient Accounting — a revenue cycle solution that manages insurance and guarantor billing, follow-up and transaction posting. These rules drive correct data to appear on a claim form for insurance reimbursement; properly configured rules help correct claims before they go to the scrubber, ultimately helping increase billers’ efficiency and improve accuracy rates.

“This engagement allowed us to identify claim issues that our billers were not telling us about,” said Parker. “Without them telling us or this clean claim workshop, billers would continue spending time fixing things the system could fix for them.”

This broad education and training opportunity led to significant improvement with the CommunityWorks℠ hospital’s clean claim rates and staff morale.

“We developed a regular, quarterly staff meeting, as well as a training manual that has about every process in it,” said Jo Beth Higginbotham, finance director. “The staff meetings have become so much more informative. We've been able to get some really good, usable information out to the registration staff.”

Cerner associates engaged with Parker from November 2017 through mid-February 2018 to optimize workflows. From January through December 2017, GWHA’s clean claim rate stood at a 66.53 percent monthly average. One year later, that figure rose to 89.01 percent.[1]

“Every dollar is critical for a small, rural facility,” said Parker. “With more time to ensure payers pay according to contract and provide training to prevent errors, we’ve drastically improved our cash in the door. We get paid within a week from several payers since claims go out clean.”

The average time from a patient’s discharge to receipt of payment for the service(s) also improved, decreasing from 40.01 in calendar year 2017 to 30.48 days in 2018 .1

“From a rural hospital perspective, we're always looking to get that clean claim through the door,” said Higginbotham. “People pay their copay, we get the claim filed and the explanation of benefits goes out right the first time. Any time we can make the process clean and simple for our clients, it's all the better.”

Consultants also leveraged Model Experience — Cerner’s strategic solution recommendations to optimize workflows — in enhancing GWHA’s registration.

GWHA leaders plan to continue working to improve these rates.

“Being a rural facility, the cash in the door is so important,” said Higginbotham. “This has helped us to get that done so much more proficiently, and we're beginning to see the financial rewards of that.”

For more information about best practices for revenue cycle management, visit our Model Experience page.

For more information about how Cerner supports community, critical access and specialty hospitals, visit our CommunityWorks page.

1 January – December 2018

Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.