Business, administrative, and office functions of a hospital are almost as important as the clinical functions to the quality of care provided. In fact, these office functions can spell the difference in staying afloat. The most successful provider organizations recognize the need for a business partner who can generate all the revenue to which the organization is entitled.

ARx, LLC, a Tennessee-based company has provided business office operations and revenue cycle services to hospitals of all sizes since 1997. ARx clients include some of the largest health care organizations in the country as well as community and rural institutions and an increasing number of Critical Access Hospitals.

Many companies offer claims management, billing and collections, but ARx is unique in its expertise in hospital administration. The company was founded by administrators from major hospital chains.

"We're not a collections agency or a company that buys back debt from hospitals. There are a lot of players like that," said J. Merle Glasgow, Vice President of Sales and Marketing. "As business office specialists, we are a value-added extension of the hospital's back office operations."

With over 115 years of combined health care industry experience, the ARx executive and operations management team takes a hands-on approach to complement their clients' existing business office infrastructure to improve results, reduce accounts receivable (A/R) days, increase cash collections and enhance overall financial performance.

"With everything changing and evolving, especially government payors such as Medicare and Medicaid, it is key to stay on top of current regulations," Glasgow said. "You might be leaving money on the table when it comes to reimbursements if you're not up to speed on the current rules and guidelines." He noted that hospitals are faced with particular stresses now as Medicare is using third parties to audit and recoup past claims paid. Hospitals that aren't billing correctly leave themselves open to these recoveries, along with violations and penalties if CMS finds it has overpaid.

Another core competency of ARx lies in their database compatibility. "We are not a technology company trying to get into the service space. We don't sell technology so our core focus is service within the hospital business office," Glasgow said. "We have integrated with all the major IT systems out there and patient accounting systems. We are very flexible when it comes to being able to receive data feeds from our clients' end regardless of the format, take that data, manipulate it for maximum efficiency within our environment, and securely provide timely updates back to their systems."

A Prime Example of Their Work

In 2006, a not-for-profit, integrated health care system in the eastern United States purchased a 60-bed Community Hospital from another large hospital system. At the time of acquisition, the hospital was operating without a business office and the health care system and the acquiring company realized an interim business office solution was needed in order to successfully integrate the Community Hospital into the company's central business office.

ARx was referred to the acquiring company as an experienced resource to handle the full business office requirements of the Community Hospital until the system conversion was complete. ARx aided integrating the Community Hospital into the existing company by acting as a hands-on seamless extension of their current infrastructure within a span of two years. With the help of ARx, the Community Hospital successfully submitted bills within 5 days of the conversion, reduced A/R of $22 million by more than 96 percent with the remaining 4 percent in patient payment arrangements, and resolved all outstanding credit balances.

ARx picks up the claims and billing process after the patient visit and coding is done. Relationships with hospital clients range from a full business office outsourcing agreement to a partial engagement. For instance some institutions still prefer to do the initial billing.

"The hospital staff may get the bill out and do the initial followup and then turn it over to a third party like ARx after 20-30 days to work out the remaining issues," Glasgow said. "We prefer to do the billing so we can speed up the receivables process. But some hospitals like to hold on to that particular aspect of their operation and bring us in afterward."

He noted that generally hospitals focus on the front end -- patient intake -- and let ARx take care of the back end.

Barbara Kram contributed to this report.