MASH's focus on core service brings more reimbursement to hospital

Dropcap372-bed for-profit hospital replaced MASH with a vendor which diluted its eligibility efforts with a variety of services. The revenue stream slowed down significantly. There's a reason that MASH focuses solely on eligibility — to insure maximum return to hospitals and their patients.

The Background

This Southern health system selected MASH for its well-known expertise in obtaining benefits for the uninsured. Three years into the successful partnership, there was a corporate restructure. The system was forced to retain another national vendor (Vendor B) which offered a number of other services, including billing and collections.

The Challenge

Nearly 25% of the adult residents of the state are uninsured, and the financial well-being of the health system hinged on its ability to maximize revenue. This system needed to differentiate between Vendor B's success in eligibility and the success it was having in other areas of the revenue cycle.

The Results

The health system conducted an audit after one year to document the success of Vendor B. While productive in some other areas of the revenue cycle, Vendor B was clearly not as successful for the hospital in the realm of eligibility. Here's the audit:

  • MASH inpatient certifications accounted for over $3.1 million more in covered charges per year.
  • MASH outpatient/ED certifications accounted for over $900,000 more in covered charges per year.
  • MASH total annual covered charges were over $4 million higher than those of Vendor B.
  • MASH's certification rates were double those of Vendor B.
Certification Comparison Chart