About the Health System
A regional non-profit health system in the southeast needed a change.
Comprised of one small and one large hospital, the system had partnered with an insurance discovery vendor in the past and while they were efficient enough, they lacked in-depth reporting and required staff to access their system to obtain and transfer information back to the hospital system.
This meant another sign-on to maintain, another password to remember and another system to learn—all resulting in extra work for hospital staff.
Seeking An Alternative
Revenue cycle leadership first encountered Nemadji at an AAHAM conference—this interaction came at a good time as they were open to evaluating other options that better fit the needs and wants of the system. They were seeking a partner that would provide them with cause reporting by department, delivering insight as to where there were opportunities to find previously missed insurance coverage.
After learning about what Nemadji had to offer with Eligibility Detection—a solution that reviews patient accounts for cases of missed eligibility—leadership decided to explore a partnership.
A Greater Return
Early in the engagement, the hospital team met regularly with Nemadji’s implementation specialists, allowing the project to stay on course and go-live quickly and efficiently. Within three weeks, the health system started seeing payments.
Nemadji has been able to assist this health system in a variety of ways—first and foremost, by finding coverage that was previously missed, resulting in $1.2M in net revenue to the system in just one year.
Cause reporting, something leadership at this system set out to find, is another. Nemadji’s Cause Reports outline the reason why a hospital was unable to identify eligibility and billing opportunities for unpaid/underpaid services.
Leadership can now pinpoint the sources of missed coverage, allowing their staff to more efficiently bill and collect adequate payment for services provided and implement internal process improvement to lessen the likelihood of missing eligibility in the future.
All of these benefits come at no extra work for the hospital staff, as partnering with Nemadji also removes the need to work within an additional system.
When asked about the most appealing aspect of working with Nemadji, the system’s PFS Director provided multiple.
“Nemadji provides weekly approval listings to our team. Rather than signing into another system, our team is able to get to work on entering the data and billing out our claims more quickly. The Nemadji monthly reporting is very helpful, and their team is open to making requested changes. They will also handle timely filing denials for coverage that they have discovered.”
Last Words from the PFS Director
“Nemadji is a great partner. We plan to continue to use them for our insurance discovery needs.
Their lines of communication are always open, and they are very accommodating. The benefit of not having to work with a vendor system was a positive improvement,” explained the PFS Director.
“The team is very approachable and that was a huge selling factor, as well as the proven track record and great references. The relationship my team has built with the Nemadjij team has been valuable—Nemadji leadership is involved in ensuring that we are pleased with our service. They are accommodating and ready to adapt to our needs.”
