How Kern Medical Closed a $963K Gap and Gained $3M in 60 Days
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Kern Medical, a 222-bed acute care teaching hospital serving Central California, faced a complex challenge: how to streamline its revenue cycle management (RCM) and reduce costly claim denials – all while supporting high patient volumes and teaching over 200 medical professionals annually through UCLA-affiliated programs.
Running such a complex operation takes precision. Kern Medical’s prior RCM vendor, however, had gaps that left them falling behind. To ease cash flow pressures, avoid delays, and better support its team, Kern Medical needed a provider-centric partner with deep expertise and experience.
Building efficiency with better visibility
The hospital first implemented Inovalon’s Claims Management Medicare Pro™, which gave staff the ability to manage Return to Provider (RTP) claims and Additional Documentation Requests (ADRs) right from their inboxes.
“I can go into the software and run reports based on exactly what I’m looking for,” said Margaret Hardman, Senior Director of Patient Accounting.
To support billers who were accustomed to logging directly into Medicare’s FISS system, the hospital also added Inovalon’s Direct Data Entry Verification™ – enabling a faster, more secure connection that simplified access to their familiar workflows.
When an industry-wide claims processing disruption created delays across healthcare, Kern Medical partnered with Inovalon to stay operational while many others were stalled.
“We were up and running pulling remits from Medicare quickly,” Hardman said. “That’s why I decided to expand to our clearinghouse and analytics side by adding Inovalon’s Claims Management Pro™ with RCM Intelligence™.”
Catching denials before they happen
One of Kern Medical’s most pressing challenges was denial prevention. The hospital’s previous vendor lacked the capability to identify potential issues early, which forced staff to react after the fact.
“Our previous system did not provide NCCI edits,” she said, “but with Inovalon I can share reporting with our Coding and Patient Access teams so everyone can quickly and easily see what needs to be fixed before a claim goes out.”
A $3M revenue swing in just two months
In April 2024, Kern Medical fell $963,000 short of its monthly cash goal. But within 60 days of implementing Claims Management Pro, the hospital saw a dramatic turnaround – surpassing its goal by $3 million.
“The revenue turnaround that Inovalon provided to us was the fastest I’ve ever seen,” said Hardman. “Going from $963K behind to $3 million ahead within two months is tremendous.”
Claims processing time also improved significantly, decreasing by 2–3 days and helping the team maintain a more consistent and predictable revenue stream.
Better reporting, stronger decision-making
It wasn’t long before Kern Medical’s team was working more efficiently and with greater confidence due to automated secondary claims, color-coded productivity dashboards, and real-time performance insights offered by RCM Intelligence.
“I now have a pie chart that shows where my holdups are, revenue, the aging of claims, and even future payments. I can go to my CFO and say, ‘This is how much we’re going to be receiving this month.’”
The upgrade not only changed how her team worked – it reinvigorated her sense of purpose.
“It made me feel incredible,” she shared. “Yesterday was my 10-year anniversary with the company, and I felt so proud that I’m still doing what I love.”
Working faster with the right tools
Before Inovalon, reporting required pulling data from multiple systems and building ad hoc tools to present information to stakeholders. Now, Hardman and her team can pull reports in minutes without interrupting daily workflows.
She recently used RCM Intelligence to identify patient encounters by ordering and rendering physicians, quantify the dollar impact, and package the results for the CFO and other leaders.
“The reporting is just there,” she explained. “I don’t have to chase down paper or ask someone to pull a status file. Everyone can see what needs to be fixed in real time – that’s the biggest win.”
A trusted partner in a critical space
Throughout the implementation, Inovalon’s team remained responsive and collaborative – something Hardman said made a real difference.
“Inovalon’s team has been fantastic,” she said. “It really makes a difference when you can count on the people behind the product.”
With the right solutions in place, Kern Medical is working smarter, faster, and with more clarity than ever before.
“Inovalon has the best solutions – and I’ve worked with a lot of systems over the past 30 years,” Hardman said. “I would recommend Inovalon to anyone.”
Stronger revenue cycles for stronger care
Kern Medical’s story shows what’s possible when you have the right solutions – and the right partner – to support your revenue cycle. From reducing denials and simplifying workflows to accelerating reimbursement, Inovalon’s RCM solutions helps providers unlock efficiency, clarity, and confidence.
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