Reference no: EM132216588
Nursing Home A is a healthcare facility based in the suburbs of a large Midwestern city. The home is a small to medium sized facility that is privately owned and been in operation for many years. Technology sophistication is limited and many administrative processes are labor intensive. Nursing Home A provides a variety of healthcare services to its patients including skilled nursing care that is covered under the Medicare program. Historically reimbursement for services rendered by a skilled nursing facility like Nursing Home A can be difficult to obtain. However, with the proper training and processes in place payment can be received quickly and easily. At Nursing Home A, this is not the case.Currently, Nursing Home A is experiencing cash flow problems. Their vendors are pushing them to pay on time although their payments are historically late. Nursing Home A would prefer to take advantage of early pay discounts but does not have the cash flow to do this. The main reason for this is that their receivables owed from its customers are historically very late in paying bills.
Typically, residents of Nursing Home A pay via 4 sources. First is Public Aid (government assistance) , 73% of residents have some form of Public Aid but only 53% of the sales revenue is generated from Public Aid reimbursement. The next source of payment is private funds (from the patient themselves). This accounts for 15% of the residents and 14% of sales revenues. The next source is Medicare. Medicare is 9% of the residents but 26% of the sales revenues. The final source is via other miscellaneous funds.
Nursing Home A recognized that a key bottleneck in cash flow was tied up in the 26% of revenue from Medicare. They determined if they could have significant improvement on Medicare receivables, there cash flow could be dramatically improved on a day to day basis.
What would you do if you were Adam, new to the company and tasked with improving the Medicare billing process? How would you have attacked this project?
Do you think Adam wasted time with simple process changes? Because much of the process is still very manual, should he have gone to technology suggestions to automate the manual processes?
If Adam did not know about Nursing Home B what else could he have done to prove his business case?
Is this effort scalable to other initiatives? Could Adam apply what he did here to other projects?
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