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FrontRunnerHC: Addressing Inefficiency in Revenue Cycle
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John Donnelly, President & CEO, FrontRunnerHC
Today, inefficiencies persist within the U.S. healthcare system due to various factors, particularly in revenue cycle management. Take the case of reimbursement, which despite healthcare providers spending millions of dollars to process efficiently fails to happen a significant percentage of the time. Often, poor reimbursement is caused by inaccurate patient information. Whether moving, changing names after marriage, or changing insurance, each change in demographic or insurance information means more potential for error and inefficiency.
Without accurate patient data, healthcare facilities and labs can forfeit revenue, incur unnecessary costs of rework, and waste valuable staff time. And the results can be felt by patients who get late or inaccurate bills. And with dissatisfied patients often comes dissatisfied referring physicians.
John (JD) Donnelly, CEO of FrontRunnerHC, is passionate about solving inefficiencies related to inaccurate patient information and the complex insurance industry. “Our objective is to help healthcare facilities and labs accurately, efficiently, and cost-effectively maximize their reimbursements for the services they provide so they can focus on delivering care to their patients.” PatientRemedi, their flagship suite of automated software, addresses patient demographics, insurance eligibility, insurance discovery, and financial disposition. It leverages available regulated data sources to verify the accuracy of patient data or fix it in real-time, and thus helps eliminate rework. While patients may forget to update their changing information, the tool helps find accurate data so the right co-pay is collected and the right bill goes to the right person at the right address on time. Clients can also use the tool to gauge a patient’s likelihood to pay, determine if they qualify for potential hardship discounts, or optimize collection efforts.
When inaccurate patient information is not fixed at the front end, organizations may find themselves with an Accounts Receivable (AR) backlog. By cleaning the patient information, they can move outstanding receivables to collected revenue.
We help healthcare organizations maximize their reimbursements accurately, efficiently, and cost-effectively, so they can focus on delivering care to their patients
For instance, when an analysis of AR charges was performed for a large health system, FrontRunnerHC identified millions of dollars in claims that had been allocated to incorrect insurance companies, and millions more that were eligible for reimbursement that could have otherwise been forfeited. FrontRunnerHC has in fact several tiers of “million-dollar clubs”—a program that recognizes the achievement of their many clients who have uncovered $1million to over $10million of earned income through the FrontRunnerHC solution each year.
While inaccurate information is always problematic, an estimated “40 percent of patients’ demographic data are missing from commercial laboratory testing for COVID-19”1. Adding to the complexity is the reimbursement claims process and government guidelines to comply with the CARES Act that provide funds for COVID-related testing and treatment for the uninsured. To help, FrontRunnerHC developed COVID-Assist, offered with a cost-sharing model, to accelerate reimbursements and reduce the claims processing burden while helping organizations comply with the CARES Act. It automates the process of gathering patient data, verifying insurance coverage, and obtaining HRSA Member IDs, and then uploads audited and compliant patient files to clients’ billing systems to submit to insurance carriers or HRSA. Donnelly cites the recent case of a client who was able to increase their monthly COVID testing capacity from 200 back in May to 463,000 in November. Moreover, the client was able to achieve this higher volume without needing additional administrative staff to gather the required patient information. Donnelly adds that the solution can actually help organizations process up to 100,000 tests a day.
Donnelly says he strives to encourage a company culture that can quickly adapt to the ever-changing patient billing and collections environment. In the future, FrontRunnerHC intends to keep collaborating with partners and clients—which include many premier U.S. healthcare facilities and labs —to drive further innovation and continue to cut the costs of inefficiency.
Cidon, Dan. “Why Patient Identity Management is Critical for COVID-19 Surveillance.” Journal of AHIMA. June 1, 2020. https://journal.ahima.org/why-patient-identity-management-is-critical-for-covid-19-surveillance.