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The California Sutter Health - Case Study Example

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This case study presents the California Sutter Health (CSH) basically is a point of service collection scheme, in which uninsured patients pay for their services up-front, before the services are rendered. The patient is billed for services rendered, and then pays.  …
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The California Sutter Health
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Download file to see previous pages As the paper discusses before they were able to enact this new system, a few problems needed to be worked out. Among these problems is the fact that the patient financial services (PFS) staff member was not able to access real-time financial information; management was not able to generate reports with enough detail; and the central business office (CBO) also could not access real-time financials. This led CSH to focus on a few key benchmarks, including gross accounts receivable (A/R) days (less capitation and credit balance accounts); cash collections; unbilled A/R days; billed A/R days; percentage of A/R over 90, 180 and 360 days; and major payer A/R days. The overall strategy employed by CSH was to empower each PFS staff member to assume responsibility over the individual accounts that they were dealing with.
This discussion outlines that as far as the front-end collections, CSH identified that were several potential problems that could be resolved if these problems were tackled before the patient received services, not after. For instance, the patient might be relying upon workers compensation, and this claim might not be paid by the insurer because accident information is missing, or the occurrence code was filed incorrectly. Or maybe there are other errors, such as the patient has two medical record numbers, or is incorrectly classified as a widow. These are examples of errors that might cause the claim to be denied, and the PFS were trained to spot these errors and correct them so that the claims could be properly processed. Before enacting the new system, CSH had to train their staff in using the new system. Registration employees, who, before, were not accustomed to asking for money were trained on the proper way to do this and interact with incoming patients.  ...Download file to see next pagesRead More
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