Phreesia

The problem

As Medicare Advantage and other managed care plans have grown in popularity, revenue cycle processes have become more complicated for Roosevelt General Hospital and Clinics, where 70% of patients are on Medicare, Medicaid or both. Staff were spending too much time searching multiple portals to determine patient coverage, and the hospital’s eligibility tool couldn’t differentiate between Medicare and Medicare Advantage plans, risking costly denials.  

Staff also weren’t consistently collecting from patients at the time of service. That translated to bigger balances after the visit and higher costs to collect. 

The solution

Phreesia brought immediate relief to Roosevelt General’s staff, who no longer need to manually check E&B for nearly all patients and receive an alert when a patient has a Medicare Advantage plan or other unique plan. With automated verification, staff can easily identify patients whose insurance requires additional E&B action. Between May 2024 and July 2024, roughly 84% of Roosevelt General’s patients whose insurance was verified through Phreesia were determined eligible, so staff were only alerted to the small remainder of patients who required follow up.

Phreesia’s revenue cycle tools integrate seamlessly into Roosevelt General’s processes for patients and staff. Patients are prompted to pay their copay during digital intake prior to their visit, and if they put a card on file, Roosevelt General automatically collects their financial responsibility after insurance claims are adjudicated. Staff don’t have to prompt patients to pay, and payment information from Phreesia flows automatically into the hospital’s MEDITECH Expanse EHR.

“The automated collections are one of my favorite things Phreesia offers,” said Jessica Camacho, the system’s Business Office Director. “With just 5 to 10 minutes of work, we can collect $5,000 to $10,000.” 

The Phreesia difference

Phreesia is now the health system’s biggest source of patient collections, thanks to a multi-faceted solution that prompts patients to pay before, during and after the visit, helping Roosevelt General get paid faster and easier.   

With Phreesia’s AI-driven copay selection, staff don’t have to sort through payer charts to determine what patients owe. The platform automatically chooses the copay for each patient and presents it to them for payment during pre-visit intake. Staff can also easily view copay amounts when checking a patient in for their visit—they don’t have to check multiple payer portals or comb through copay charts.