Barlow Respiratory Hospital

HRG/ Barlow Respiratory Hospital Client Case Study/ Los Angeles, California

Barlow Respiratory Hospital is a licensed 105 bed Long Term Acute Care Hospital (LTACH) founded in 1902. They operate three locations in the greater Los Angeles area and are a specialty hospital that primary serves patients with respiratory illness and other chronically complex medical conditions. Patients are typically referred from short term acute hospitals and intensive care units throughout Los Angeles County. Barlow's reputation for expertise and quality, has on occasion, has led to patients being referred to them from hospitals beyond the boundaries of Los Angeles.

Barlow’s payer mix is comprised of fee-for-service Medicare, Medicare/Medi-Cal, Medi-Cal and some managed care and commercial insurance covered patients.

Business Situation

Managing Patient Financial Services (PFS) function as an in-house department, including monitoring and adjusting to the complexities of changes in Medicare and Medi-Cal claims processing rules had become unwieldy. As a small hospital with a small staff, they needed help.

PFS billing challenges:

  • The settlement of Barlow patients’ accounts often involves billing both the primary and secondary insurer of the patient.

  • Securing authorization from the secondary payer is often on a retroactive basis.

  • Payment resolution typically becomes more complicated than with short stay acute hospital accounts.

  • High percentage of Barlow's accounts dealt with unique Medicare payment rules involving: interrupted stays, short stay outliers, high cost outliers and the need to process Medicare Part A, Medicare Part B and a secondary insurance. component on a high percentage of Barlow’s accounts while

  • Medicare MS-DRG System and the Medi-Cal APR-DRG System


Healthcare Resource Group (HRG) was engaged by Barlow Respiratory Hospital in 2013 to support the patient financial services function.  HRG employed an onsite manager for Barlow and in 2014 transitioned their business office functions to their OutParnering™ Center in Spokane Valley, Washington where they provided complete remote business office services.

Information was accessible for record keeping in real time for Barlow, due to HRG performing nightly transfer of information from Barlow's Meditech System to HRG’s internal patient account management systems. Accounts were closely followed utilizing HRG’s systems while all account transactions and follow-up activity are concurrently recorded in the Barlow Meditech BAR system. Keeping information as easily accessible as if it were all being handled by Barlow's in-house departments. Payments on accounts were received and deposited by Barlow and copies scanned to HRG for posting and follow-up.


Barlow Respiratory Hospital’s current patient accounting function have steadily improved since being taken on by HRG's OutPartnering™ Center and handled by their Complete Business Office (CBO) service division. As a result of HRG's services, Barlow patient accounts receivable balance, as well as, the average time-to-collect has been reduced by 30%.

The HRG team has exhibited excellent leadership and exceptional organizational skills. They are, without exception, motivated and dedicated to managing Barlow’s accounts efficiently and effectively. I am happy to recommend the services of HRG and would be happy to discuss our HRG experience with any of your clients or potential clients. Please contact me at any time, by phone 213-250-4200 x 3304
— Ed Engesser, Chief Financial Officer, Barlow Respiratory Hospital

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Molly Bauer