UT Health San Antonio Earned an ROI of 417%

The Client:

The University of Texas Health Science Center at San Antonio (UT Health San Antonio) is a part of the University of Texas system, a large university health system with locations throughout the state. As a teaching hospital, it serves San Antonio and a 50,000 square mile area of central and southern Texas. More than 1,100 of the hospital’s providers are active on the EPIC billing platform.

The Challenge:

In the wake of COVID-19 pandemic and its associated staffing shortages, UT Health San Antonio was facing tight budgets and a leaner-than-usual workforce. A sufficient revenue integrity strategy was not in place, so reimbursements were not being monitored appropriately. Additionally, a lack of adequate resources meant that UT Health San Antonio lacked the capacity to manage insurance payments to ensure accurate reimbursements. Processes needed to be established, and leadership was looking to enact a revenue integrity program to ensure money was not being left on the table. The goal was to identify, track and recover any revenue that was not paid properly by the payer, based on contractual rates that had been agreed upon between the University and the payers.

The Solution:

UT Health San Antonio partnered with TriZetto Provider Solutions, a Cognizant Company, to adopt their contract management and adjudication engine technology. The Advanced Reimbursement Manager (ARM) tool was chosen to identify trends, report on erroneous payments and maximize revenue being left on the table. Being short staffed meant that UT Health San Antonio did not have the resources in place to use the tool to the best of its ability, so Cognizant’s Revenue Recovery team was brought in as a service partner to power the revenue integrity program for the organization. When used in tandem with the Advanced Reimbursement Manager solution, Cognizant’s subject matter expertise can amplify success. After merging leading technology with expert service, the team was able to establish workflows and optimize their processes to work toward gaining accurate, timely reimbursements to boost earnings.

The Results:

Over the course of a year, Cognizant’s subject matter experts identified over one million dollars in total underpayments from one specific large national payer. By incorporating a fully outsourced revenue integrity partner and its advanced contract management technology, UT Health San Antonio was able collect this revenue rather than letting it go unidentified and uncollected. Utilizing the Advanced Reimbursement Manager solution, together with services provided by the Revenue Recovery team, the University of Texas Health Science Center at San Antonio collected a total of $775,000 in additional revenue so far, amounting to a 417 percent return on investment.