How AR technology is helping advance payment processing at Avera Health

July 07, 2022

Accounts receivable technology advances payment processing at Avera Health. A/R management partnership with U.S. Bank drives efficiency, centralization and improved patient payment experience.


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For Avera Health, efficiently collecting and posting payments from insurers and patients is a massive, ongoing challenge. To leap the high bar that’s been set in health care accounts receivable (A/R) management, Avera Health needed a banking partner with exceptional industry-specific lockbox expertise and technology.

It found that and more in U.S. Bank.


Accounts receivable challenges in health care

Based in Sioux Falls, S.D., Avera Health offers a full continuum of care through 35 hospitals and more than 200 clinics, as well as senior living, home care, hospice, and sports and wellness facilities and services. The organization serves a population of nearly 1 million people in a total of 100 communities in its home state as well as Minnesota, Iowa, Nebraska and North Dakota.


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A decade-long journey

Since 2011, the company has been on a journey toward financial centralization, greater efficiency in A/R management, and more patient-friendly billing and collection practices. U.S. Bank has been right by its side, helping guide the way.

Avera is working to improve cash flow and cut costs through greater payment processing efficiency, while at the same time addressing patients’ desire for a more convenient payment experience. Two things are critical to that effort: A/R management technology and the company’s implementation of a centralized business office for hospital operations.

The client:

Avera Health, an integrated health system with more than 330 locations across five states.

The challenge:

Efficiently collecting and posting payments and improving the patient payment experience.

The solution:

U.S. Bank Wholesale Lockbox and Payment Consolidator.

Wholesale lockbox improves medical collections

For years, the U.S. Bank Wholesale Lockbox service has been a key tool at Avera Health for achieving improved cash flow and collections efficiency. The company has used wholesale lockbox for collecting both hospital patient “self-pay” payments and some insurance payments.

Patients and insurers no longer mail payments directly to Avera Health facilities, freeing Avera employees from opening the mail, preparing the deposit, keying in the transaction and performing balance and reconciliation duties. Instead, payments are mailed to a lockbox, where U.S. Bank performs those duties and deposits them. Avera receives automated posting files that are easily entered into its patient accounting system. As such, wholesale lockbox saves staff time and accelerates the deposit process.


The power of lockbox imaging

Avera leverages the bank’s lockbox imaging capabilities for both patient self-pay and insurance payments, which helps drive efficiency. Each month the bank image captures 75,000 payment-related documents for the company.
For patient self-pays, the bank captures an image of each check or credit card slip, as well as the accompanying remittance coupon, eliminating a lot of manual work for Avera and producing ready-to-post remittance files


A comprehensive health care receivables service

To process payments from health insurers, Avera uses wholesale lockbox in combination with U.S. Bank Payment Consolidator, the bank’s comprehensive health care receivables service. The bank receives a claim file and captures images of the remittance check, the explanation of benefits (EOB) documents, and critical related correspondence. Imaging enables the bank to deliver balanced remittance files in an industry-standard ANSI X12 835 format and provide Avera with searchable documents for researching exception items.

“We receive an electronic posting file that can be scripted into our system, rather than someone having to look at every patient account  on an EOB printout and hand keying in all of those transactions,” explains Mary Wickersham, vice president, central business office services, for Avera.

“We receive an electronic posting file that can be scripted into our system, rather than someone having to look at every patient account"

Consolidating wholesale lockbox supports centralized business office

Centralization is also driving efficiency at Avera. In the past, from a financial perspective, all the company’s hospitals operated independently, and each hospital that used a lockbox for collections had its own service. However, Avera created a central business office structure several years ago. In doing so, the company worked with U.S. Bank to consolidate its hospital lockboxes. In 2016, Avera consolidated to a single U.S. Bank lockbox for hospital patient self-pay payments.

Avera continues to work on consolidating the processing of its hospital-related insurance claim payments with the goal of getting down to a single lockbox in St. Paul, Minn., for those payments as well.


Improving the patient payment experience

The lockbox consolidation has coincided with Avera’s development of a consolidated patient billing statement, enabling patient families paying for care provided by multiple Avera facilities to receive one bill, direct payment to one wholesale lockbox, and if they are on a payment plan, to be on just one plan. “It just makes it easier for patients to manage their bills,” Wickersham says.

Instituting A/R automation across the enterprise

U.S. Bank health care treasury specialists continue to consult with Wickersham and her Avera colleagues about how new treasury automation tools can support the company’s goals. Every hospital has different needs, structures and patient accounting system setups. For nearly a decade, U.S. Bank has worked to understand Avera’s platform, and “mold some of their tools around our needs,” Wickersham notes.

Going forward, Avera envisions standardizing the revenue-cycle process beyond the hospital side of the business to include its vast network of clinics and other facilities. The foundation for centralization and digital solutions has been set, and U.S. Bank is committed to partnering with Avera in that effort. 

“It’s been a good relationship,” Wickersham says. “U.S. Bank is always open to new ideas and different ways of doing things to help us be successful.”

Next steps

To learn more about how U.S. Bank services like Wholesale Lockbox and Payment Consolidator can simplify and streamline your accounts receivable management, contact your U.S. Bank representative.


If your healthcare payments system is overworked, perhaps it’s time to get it in shape. Contact us to learn more about efficient payment best practices.

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