Case Studies

Provider:             Gwinnett Hospital System

Bed Size:             553 beds

Region:                Lawrenceville, GA

HIS:                        McKesson STAR

The Opportunity

Gwinnett Hospital System operates a well-run revenue cycle division.  Like most hospitals, they look for every possible dollar they can collect.  They utilize several business partners to help identify third party coverage for patients that may not have it.  They have a front-end patient advocacy vendor, an insurance eligibility and payment estimator tool they use on the front end, a third party aged insurance collection vendor, a Self-Pay early out vendor, three bad debt collection vendors, and a secondary bad debt collection vendor.  NRC proposed a solution that would complement these other companies’ efforts, not overlap them.

The Solution

Gwinnett Hospital System agreed to implement Nemadji’s back-end data analytics solution to help identify and recover lost revenue from Medicare and Medicaid, as well as other non-government third-party payers that they themselves and other vendor partners were not positioned to catch.  NRC finds eligibility and coverage as a result of inconsistencies in a patient’s historical service data, eligibility status changes, and information that can only be captured through proprietary technology and sophisticated matching methodologies.

The Results

Nemadji Research Corporation captured three years’ worth of historical patient data to begin the program.  In the first 10 months, $1.4 million of additional revenue was received by the hospital system as a result of NRC’s analysis.  After twelve(12) months, NRC generated  just over $2.1 million on accounts that had either been written off to bad debt or were deemed Charity Care by the hospital.    Approximately 77% of the accounts had retroactive eligibility.

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