Case Study: Baylor College of Medicine recovers $4.2M and improves reimbursements with Experian Health

Real-time contract analysis improves reimbursements now and later

Baylor College of Medicine’s Houston-based faculty practice plan—more than 1,200 physicians across 21 clinical departments—faced inconsistent payer contract performance across 50+ managed care agreements and over 500,000 annual claims. Manual, labor-intensive audits and unreliable patient-estimate processes led to missed underpayments, billing delays, fragmented denials management and rising patient bad debt.

By deploying Experian Health’s Contract Manager, Contract Analysis and Patient Responsibility Pricer, Baylor automated claims valuation, modeled “what if” contract scenarios and generated accurate patient estimates at check-in. The practice recovered $4.2 million, corrected systematic payment errors, strengthened its negotiating position with payers and increased point-of-service collections (about 18,000 estimates in 2011 representing $27M in charges).

Baylor College of Medicine

Richard Allison

Director of Baylor MedCare