Eastern Maine Health System

The Chappelle Group (TCG) Case Study

Eastern Maine Health System (EMHS) and other Maine Hospitals v. State of Maine Medicaid

How The Chappelle Group led Eastern Maine Health System (EMHS), and other Maine hospitals, in challenging the State of Maine to extend timely filing on Medicaid claims. TCG efforts allowed for a potential $50M cash recovery of stalled AR for Maine Hospitals. 

Overview

Eastern Maine Medical Center (EMMC)is a part of EMHS, dba today as Northern Light Health, a $1.5B rural health system with nine hospitals, 1,020 physicians and 127 locations in Maine, USA.  The hospital was experiencing issues with the State of Maine and the Department of Health and Human Services (DHHS) relative to Medicaid claims from 2010 to 2014.  Due to some major internal system programming issues, DHHS and the State of Maine lifted timely filing which prevented hospital claims from proper and timely processing. For two years DHHS lifted the timely filing statue but did not fix the internal system issues. In February of 2014, DHHS reinstalled timely filing for all Medicaid claims beginning March 1, 2014. The decision sent shock waves throughout the Maine Hospital Association community. Collectively, the hospitals totaled more than $100M in stranded Medicaid AR.  The nine hospitals within EMHS had approximately $17M in stranded AR.

TCG was engaged by EMHS to perform internal management of RCM/PFS, providing leadership to six of the nine EMHS facilities.  At the onset of the engagement, TCG experts began to construct a plan of action to address this issue. With the support of the EMHS board and senior leadership, TCG created a lobbying campaign targeting the Maine Hospital Association (MHA), the Governor of Maine, and the head of DHHS.  Within two weeks of the campaign initiation, TCG had met with all parties and negotiated an extension of the Medicaid timely filing to September 1, 2014. This decision allowed EMHS and other hospitals an additional seven months to fully adjudicate all old balances.

For EMHS, this task was daunting. The health system had nine hospitals and six different legacy AR systems.  Their challenges continued with limited AR staff and minimal expertise to perform the re-billing necessary for a project with multi-tiered issues.  The leadership team tasked TCG to rectify the problem. In total, EMHS had 186k accounts and $35M in total AR, both primary and secondary accounts.  All of these accounts needed to be reviewed, analyzed and rebilled through the DHHS portal.  TCG analyzed the total cash yield of $8M and $4M in revenue lift.

TCG created the EMHS MaineCare AR Work Down 2.0 Committee and began to meet with all CEOs/CFOs and PFS departments system-wide.  Internally, TCG created an off-site, 50-person team at its headquarters in Greenbelt, Maryland.  The team consisted of AR management, staff and analysts who successfully performed on the project.  Our operating approach was to educate and train to ensure non-replication of the issue.

On March 1, 2014, TCG began creating agnostic databases to receive Medicaid accounts for all nine hospitals.  Next, applicable analysis and reporting mechanisms were created to show weekly project progress to all hospital CEOs and CFOs.  The project was a shared cost by each of the nine hospitals, resulting in TCG billing hours per facility for the project.  Throughout the engagement, TCG encountered multiple challenges from system, regulatory to personnel.  These barriers allowed for critical learning and ultimately made the project, team and health system stronger.

Goal

  1. Reprocess all stranded Medicaid AR within all 9 EMHS hospital
  2. Yield a cash and lift yield minimum of 15%
  3. Educate and train all 9 EMHS hospitals on new DHHS Medicaid billing procedures.

Approach

  1. Reprocess 185k in total stranded AR accounts over 6 different AR systems: After careful evaluation and analysis, TCG created a 50 person AR and analysis team located at its headquarters in Greenbelt, Maryland.
    1. (a) Implemented Operational Approaches: Technical, Production, Solution and Educational.

(b) Created internal databases and agnostic programming to intake all accounts from six various systems, compiling in issue categories for analysis and reprocessing into the DHHS Medicaid billing system. Performed monthly update reporting to the EMHS Board of Directors/ CFO which consisted of board meetings with all nine hospital CFOs led by the EMHS CFO.

(c) Creation of a system-wide RCM committee which allowed all stakeholders to fully understand project results.

  1. Accomplish cash and revenue lift of minimum 15%. TCG exceeded the goal accomplishing a 32 percent total yield for the project.
  2.  Educate and Train all Nine Hospitals.  TCG held system-wide RCM training on new DHHS Medicaid billing practices.Results

Results:

TCG’s leadership and best practices modeling resulted in the collection of $8M in total cash and $4M in revenue lift. This was a 32% total project yield, which was a 100 percent increase from the expected project yield.

Conclusion:

As a result of TCG’s hard work and strategies, the company was publically recognized and presented an award for their success on the Medicaid project.

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