A major health system in the Southeast found a game-changing solution that transformed their VA reimbursements. Discover how the right expertise and technology unlocked this revenue and improved patient care for veterans.
The Challenge
A leading non-profit healthcare system in the Southeast United States, managing over 2,500 beds and generating nearly $4 billion in annual revenue, was facing significant challenges with slow and complicated Veterans Administration (VA) claims processing.
Ensuring that veterans received the support and services they deserved was a top priority, but the existing processes were hindering their ability to deliver optimal patient experiences.
Determined to overcome these obstacles, the health system embarked on a mission to improve operational efficiency and achieve better outcomes for both the veterans they serve and the organization as a whole. They explored various strategies and solutions aimed at streamlining complex revenue cycle management, especially for VA claims processing
The Solution
The health system chose to partner with EnableComp to deliver a holistic approach to complex account resolution for VA claims. EnableComp launched its Day One service, taking over VA claims from initial claims submission all the way through final payment with a focus on yield enhancement.
Through the E360 RCM™ platform’s proprietary predictive analytics and modeling algorithms, EnableComp gleaned invaluable insights into the health system’s complex claims resolution process. This led to identifying and addressing the underlying issues that had created denials for the health system including, but not limited to, the following denial categories:
• Prior Authorization Requirements and Modifications
• Medical Necessity
• Patient Eligibility Issues
• Billing Related Requirements
These process enhancements provided the necessary improvements to enrich the patient experience and the other foundational pillars of the revenue cycle program, leading to optimized financial outcomes for VA claims.
Bottom-Line Impact
$35M annual cash uplift.
