From $963K Behind to $3M Ahead: How Kern Medical Fixed RCM Fast

As a 222-bed acute care teaching hospital and the only advanced trauma center between Fresno and Los Angeles, Kern Medical serves a diverse, high-volume patient population while training over 200 medical professionals annually through its UCLA-affiliated residency programs.

That level of complexity demands precision, especially in revenue cycle management (RCM) – but their previous vendor provided limited functionality and results.

The organization saw an increase in team efficiency once it implemented Inovalon’s Claims Management Medicare Pro™, said Margaret Hardman, Senior Director of Patient Accounting.

In her inbox each day, she can easily see and manage Return to Providers (RTPs) and Additional Documentation Requests (ADRs).

“I can go into the software and run reports based on exactly what I’m looking for,” she explained.

For billers still accustomed to logging directly into DDE to fix issues, the hospital uses Inovalon’s Direct Data Entry Verification™ to gain a fast, secure connection to the system.

And when an industry-wide claims processing disruption sent many hospitals scrambling, Kern Medical got back to normal by partnering with Inovalon to keep things moving as quickly as possible.

“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™.”

“We needed a solution to effectively address one of our biggest problems – claims denials,” Hardman noted.

Proactively catching potential issues was a challenge with the hospital’s previous system, and staff members weren’t able to recheck eligibility before claims were submitted. The claims scrubbing performed by the hospital’s previous vendor was often inadequate, with ensuing denials creating delays, extra work, and strained coordination across departments.

“Our previous system did not provide NCCI edits, 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.”

The results have been significant.

In April 2024, Kern Medical missed its cash goal by $963K. But within 60 days of implementing Claims Management Pro, the hospital was $3M ahead of its goal.

“The revenue turnaround that Inovalon provided to us was the fastest I’ve ever seen,” Hardman said. “Going from $963K behind to $3 million ahead within two months is tremendous.”

Plus, claims processing time has decreased by 2-3 days because of Inovalon’s solutions, enabling the hospital to keep its revenue flowing quicker and more reliably.

It didn’t take long for Kern Medical’s team to benefit from automated secondary claims, improved scrubbing capabilities, productivity dashboards, and enhanced reporting. Hardman lit up when asked why she pushed for the upgrade to Claims Management Pro with RCM Intelligence.

“Wow, RCM Intelligence is something else,” she said. “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.’”

That level of visibility was a game-changer – not just for operations, but for morale.

“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.”

“Inovalon helps us work smarter, not harder,” Hardman said. “My team is very happy with these solutions. They’re seeing the difference and able to produce more, ensure better quality, and reduce denials.”

Before implementing RCM Intelligence, Hardman had to rely on business analysts to manually pull reports from multiple systems and build ad hoc tools to report to the organization’s CFO. With the data now at their fingertips, she and her team can quickly prepare reports without disrupting their existing workflows.

What used to take a week to compile can now be done in minutes. Hardman recently used RCM Intelligence to pull up patient encounters based on ordering and rendering physicians. The reporting, which showed the dollar impact and age of the receivables, was then easily packaged for the CFO and other stakeholders.

“Inovalon’s team has been fantastic,” Hardman said. “It really makes a difference when you can count on the people behind the product.”

Hardman said having an industry-leading partner has empowered the hospital to greatly enhance its revenue cycle management. Inovalon’s responsiveness and provider-centric approach are particularly important, she noted.

“Inovalon has the best solutions – and I’ve worked with a lot of systems over the past 30 years. I would recommend Inovalon to anyone.”