Tight processes crucial for efficiency, effectiveness
From intake to the back end, healthcare providers need a revenue cycle management system that will provide a seamless workflow for each episode of care. From the moment a patient registers in the facility, it is imperative that the correct information follow along each point of care so that accurate billing information can be processed and sent, RCM vendors say.
"It's the old 'garbage in, garbage out' analogy," said Taylor Moorehead, partner for Carmel, Ind.-based Zotec Partners' west region. "We deal with hundreds of different information systems across the country and no matter how good the technology is, it still comes down to reliance on humans to put in the right field in the right format."
Getting the information right at the initial "counter encounter" is paramount, Moorehead said, because this is where the chances for getting something wrong are at their highest. Moreover, he said, failsafe measures should be implemented at various points down the line.
"It's still a 'people' process," he said. "The linkage is especially critical between the RCM company and the provider. That communication channel has to be very fluid and transparent to the extent that any denials are handled by a team."
Feedback has to be continual up and down the line to determine root causes of claims denials, Moorehead said.
"They need to get to the bottom of these denials and what specific errors are being made," he said. "It has to be a candid process or it won't work."
The workflow process is a bit different at the small community hospital level, so it makes sense to modify the RCM system in a way that one person can manage several functions, said Steve Everest, executive vice president of financial solutions for Houston-based Prognosis Health Information Systems.
Prognosis has developed a system specifically for community hospitals and their unique workflow, Everest said.
"Community hospitals have a different workflow than their big city cousins," he said. "Where a large health system typically has people assigned to case management, revenue cycle and clinical care, those lines are usually blurred at the community hospital level."
Therefore, the Prognosis system increases the capacity for one person to perform all three functions without having to log on to separate systems.
"That way someone who wears a lot of hats can get a single user experience," he said.
Having a simple and effective workflow makes an organization more proactive and the entire revenue cycle smoother, Everest said.
"Silos are still a problem and we're trying to ease it," he said. "But we are helping our clients prepare for the future because with the challenges coming down the road, their jobs will get harder, not easier."
Tracking down $$$
Approximately 15 to 30 percent of provider revenue now comes directly from patients - double what it was 10 years ago. That makes tracking down patient deductibles, co-pays and cash liabilities more important than ever, says Kevin Weinstein, vice president of marketing for Louisville, Ky.-based Zirmed.
"Back then it was easy to ignore patient payments because they represented only a fraction of revenues," he said. "It is much different now."
Revenue collection is about efficiency and effectiveness, Weinstein said. On the payer side, providers have gotten to be much more efficient at claims filing and on average have about 90 percent of their claims paid on a timely basis, he said.
"It is all about efficiency - how to get that 90 percent with lower expenditures and fewer people," he said.
The effectiveness quotient refers to patient collections, which Weinstein says providers only receive about 60 to 70 percent of what they are owed. "There is plenty of room for improvement on this front," he said.
ED: Emergency dysfunction
The chaotic environment of the emergency department is the ideal place to install an automated RCM system. Even in the era of heightened cost consciousness, the ED remains over-utilized as a patient entry point, comprising 60 percent of all hospital admissions, said Mikael Ohman, COO for Dallas-based T-System.
Launching its RevCycle+ in June, the company has developed a comprehensive system specifically designed for the ED that links clinical processes with coding and billing to optimize the revenue cycle. By capturing patient data at the intake point, the system ensures accurate, up-to-date insurance information as well as documenting all billable services.
Over the past few years, the company has transformed its original clinical documentation system into a tool that builds the revenue cycle into the equation so that the components work together. Ohman says the bundling of functions has become a necessary model for running the ED.
"The emergency department is a mini hospital unto itself," he said. "It has historically been an island. If any environment needs an optimized workflow, it is the ED."