Revenue Cycle Process Analysis at Montefiore Medical Center

Montefiore Medical Center is an integrated healthcare delivery system serving patients in the Bronx and southern Westchester counties. The facility treats a significant number of patients through its Emergency Room Department (ED). Montefiore’s ED is experiencing a significant number of denials and reduction of payment for care rendered by insurance companies including Medicaid and Medicare. The Capstone team was asked to identify the root cause of this problem and provide recommendations on how to rectify the situation. The team undertook a comprehensive review of the registration process, as well as the interface between the registration and billing systems. The team then proposed ways to improve the front-end eligibility verification process and suggested enhancements to the interface. The expected result is a decrease in overall payment denials and greater accuracy of up-to-date insurance verification.