Highlights: Hospital Billing and Physician Billing, EDI Claim Submission Service, Automation, Remittance, Reimbursement.
UPMC is a $16 billion world-renowned health care and insurance provider in Pittsburgh, PA with 36 academic, community, and specialty hospitals, 8,500 licensed beds, more than 600 doctors' offices and 80,000 employees.
UPMC wanted a partner who aligned with their strategic objectives, as well as a vendor that offered flexible, customizable, and scalable solutions.
Cirius Group software is used to automated corrections of claim errors and edit claims to achieve 90% clean pass through rates with no human intervention and achieve 1.0% or less denial rates. Immediately after implementation, UPMC collected over $25 million from previously unbilled claims/backlogged receivables, within only 3 months of go-live! They saw a dramatic reduction in A/R days overall and especially A/R days over 90 – all while significantly reducing overall cost to collect by more than 25%. With a UB04 claim volume of 6 million claims per year, they have needed only 12-25 billing FTE's with the help of our automated solutions to produce these outstanding results.
El Camino Health includes two not-for-profit acute care hospitals in Los Gatos and Mountain View, CA with a bed count of 443 and growing, as well as 11 urgent care, multi-specialty care, and primary care locations through their affiliated partner Silicon Valley Medical Development (SVMD).
El Camino Health was struggling to produce clean claims with a completely manual claim editing process. This resulted in a high rejection and denial rate, high A/R days, and ultimately unpaid claims and lost cash collections.
With Cirius Prebill Claims Management Solution, their clean claim percentage skyrocketed and the need for manual intervention from billing staff dropped dramatically. The most impressive results were seen in the cash collections- they exceeded their cash collections targets 3 years in a row, each year collecting $44M-$60M more than their target goal!
In addition, they attained a long-awaited goal in 2019- they exceeded their cash collection targets for 12 months in a row! They even reached an all-time high for their physician billing cash collections. We are proud to say that our partnership has resulted in tremendous value and truly enviable KPI’s for ECH!
Results of Notable Providers
An academic health system experienced these results after implementing Cirius solutions:
The University or Iowa Hospitals & Clinics experienced these results after implementing Cirius solutions:
Manual Work Automated: 45 billing FTE’s down to 18.
A/R Days Record Broke: Dropped from 56 days to 47 days in less than 3 months, lowest in hospital history.