CLH was able to analyze claim rejections and denials and make quick improvements using TITAN, resulting in a $200,000 increase in net revenue in just a two-month time period.
reduced unexpected claim denials to 4.99%
increased net revenue
Clinical Laboratories of Hawaii and its affiliate, Pan Pacific Pathologists, provide a full range of anatomical and clinical tests for Hawaii’s medical community. The organization maintains more than 54 locations throughout the Hawaiian Islands, processes more than five million tests per year, and its 860 employees include specialists across a wide variety of laboratory disciplines.
Today’s large clinical reference laboratories, like Clinical Laboratories of Hawaii, face several revenue cycle challenges, from changing regulations and declining Medicare reimbursement, to tracking a large volume of claims – many of which are for relatively small dollar amounts.
When claim denials occurred, there was a tendency to focus on resolving the high-dollar claims while ignoring a large number of low-dollar claims. This resulted in write-offs that left substantial money on the table.
As the organization continued to grow, it became apparent that it needed a solution to streamline its claim denial management process and improve how it monitored reimbursement and claim denial trends to proactively prevent problems and maximize revenue.
After evaluating numerous solutions, Clinical Laboratories of Hawaii selected eSolutions’ TITAN for denial analysis. TITAN provides a real-time, transparent view into essential business metrics. It includes a powerful system built on more than a decade of historical claims data from providers across the country. TITAN analyzes ANSI 835 remittance notices for benchmarking against regional peer practices, based on specialty and geography. The solution delivers crucial information to help refine daily processes that reduce denial rates, accelerate cash flow, increase efficiencies and anticipate audits.
Using TITAN’s comparative analytics and key metric insights around reimbursements, productivity and utilization, Clinical Laboratories of Hawaii was able to analyze trends to identify the root cause of claim denials. Focused remediation efforts led to a reduction of unexpected claim denials from 7.92 percent to 4.99 percent in a two-month time period, increasing net revenue by more than $200,000. The intuitive design of TITAN enabled Kim Marie Ek, the organization’s controller, to begin using the solutions with minimal training. “When you have a question, it’s really easy to dig down into the data,” Kim said. “The people at eSolutions have been very helpful in helping us learn and use these systems.”
Kim uses TITAN to track reimbursement and denial trends. “I’m interested in reviewing key reimbursement and denial metrics over time in order to identify trends, and TITAN allows me to do that. With TITAN, I can see unexpected denials – as I define them,” Kim said. She added that they’re able to pinpoint problems using TITAN that they couldn’t before, leading to a decrease in write-offs.
Using TITAN also enabled Clinical Laboratories of Hawaii to better deploy resources for greater effectiveness when working to resolve denials.
“One thing that TITAN made obvious to me was just how much effect our two primary payers have on our denials rates, and therefore our cash flow,” Kim said. “After discovering that, we shifted our efforts to focus the majority of our time working denials from these two payers, and that has helped our organization tremendously.”
Clinical Laboratories of Hawaii also uses TITAN to pinpoint the root cause behind many of its claim denials – one example is denials related to patient insurance eligibility. “You can look at the payer’s website one day and the patient looks eligible, then look at it another day and they’re no longer eligible,” Kim said.
After discovering that eligibility errors were the cause of many denials, Clinical Laboratories of Hawaii refocused its staff to ask questions regarding why the eligibility verification software wasn’t working as robustly as it should be.
In addition, TITAN’s reporting capabilities have provided greater insight into the organization’s performance. “The comparative analytics capability in TITAN gives us great data to provide to our executives,” Kim said. “We can see how we compare against peers, show where our processes are working, and the data helps us justify our technology investments.”