Inpatient Medicaid Managed CareReceivable

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.