Cookeville Regional will look to collect more revenue from insurance companies after the Board of Trustees approved a contract Thursday with a healthcare consulting firm.
CEO Buffy Key said the firm will consider Cookeville Regional’s processes from registering a patient to the final bill. Key said the medical center has been searching for ways to improve its collection processes due to the current state of insurance reimbursement challenges.
“We get a lot of automatic denials on a lot of people’s procedures,” Key said. “And so then that takes the human after the fact of trying to appeal that and going through all that. So we are trying to designate what those processes are, the new standard processes, to see if we can eliminate some of those denials.”
Key said insurance companies use artificial intelligence to review insurance claims, a new complexity in reimbursement. Key said she wanted to make it clear that this is a move to get more revenue from insurance companies and not people.
“People pay high premiums for their insurance,” Key said. “We all do, but at the same time, sometimes insurance denies certain things, and then they won’t pay the hospital, or the physician, or the provider, or whatever. This will help us be sure that we get the payment that we are owed.”
CRMC CFO Tommye Rena Wells said the contract will cost an estimated $3.2 million. Wells said she is confident that the services will be well worth the investment.
“The amount of revenue that we are gonna get back will far exceed the expenses that we will be paying them,” Wells said. “Also, the company part of those fees will be contingency-based, so they will be on the hook for making sure they meet certain metrics that we all mutually agree upon and set forth that they meet.”
Wells said Chartis will work with Cookeville Regional’s processes for several months. Key said her team is great, and that she hopes the partnership with Chartis will reveal new resources for her team to do their job more efficiently.
In other business, the Finance Committee and the Board of Trustees both removed the agenda item to review the annual audit. Trustee Chairman Danny Rader said the audit is not finished, and the review will be pushed to next month’s meeting.
