Inpatient Medicaid Managed CareReceivable
Bronx Lebanon Hospital Center
Bronx Lebanon Hospital Center (BLHC) is a healthcare system with two hospital divisions (Concourse and Fulton). BLHC has provided healthcare services for over 100 years to the communities of the Southand Central Bronx. An increase in the number of denied and delayed claims by the Hospital Center’s insurers has led to a significant increase in their account receivables. As a result, BLHC management wants to reduce its current inpatient Medicaid Managed Care receivable. The Capstone team worked with BLHC’s management team to identify the most significant causes for the growth of the receivables it relates to reimbursement denials from insurers. The team analyzed BLHC’s registration and billing data, interviewed departments that are part of the billing process, and reviewed insurance contracts and registration training manuals. Since additional resources were limited, the Capstone team identified areas of BLHC’s billing process that would benefit from changes through the reallocation of resources.
Identification of Ancillary Department Bottlenecks Increasing Length of Stay
The Capstone team was asked by Cabrini Medical Center to identify issues that affect hospital length of stay (LOS). While various factors may contribute to the increased LOS, one of the most critical issues at CMC is the work processes within key ancillary departments. After assessing five ancillary services in Phase I, the Cardiovascular Lab and Environmental Services Department were chosen for closer assessment in Phase II. The project included conducting interviews, reviewing medical charts, analyzing data, shadowing environmental services staff and observing cardiovascular lab workflow to determine what patterns contributed to inpatient delays. For the final phase of the project, the Capstone team identified the root cause of these delays and provided recommendations to improve efficiency within these two ancillary departments and reduce LOS. This Capstone was made possible with the support from an anonymous donor through FJC: A Donor-Advised Fund.
Planned Parenthood of NYC
Planned Parenthood of New York City (PPNYC) tasked the Capstone team with forecasting the impact to the organization when emergency contraception (EC), now available only by prescription, becomes an over-the-counter (OTC) drug. The specific objective of this project is to assess the impact on PPNYC’s revenue, patient volume, and number and type of services when PPNYC and its competitors offer ECover-the-counter, and to make recommendations on maintaining revenue. Currently, patients who come to PPNYC for EC are encouraged to make a follow-up appointment and are offered a variety of services. However, if the number of initial EC visits declines, PPNYC is facing both a loss of patients as well as a revenue loss. If PPNYC does lose patients because EC is offered OTC, then PPNYC needs to find away to “get people in the door.” The Capstone team found that although visits to obtain a prescription for EC currently provide PPNYC with a significant source of revenue, PPNYC has several options in distributing EC when it becomes OTC that will preserve a stream of new patients and revenue. This Capstone was made possible with the support from an anonymous donor through FACT: A Donor-Advised Fund.