CIOs Beef Up Their RCM Operations in the Post-Reform World

Emory Healthcare, a six-hospital system in Atlanta, uses Atlanta-based Ingenious Med’s RCM solutions in its hospitalist group. Karen England, CPC, revenue cycle administrator and assistant director of revenue cycle operations at Emory, says the biggest benefit on the new system is that the physician knows what he or she did. “They are the ones who are closest to the charge and to the patient. We also saw more of a collaboration relationship between my team and I, and with the physicians. It wasn’t bad before by any means, but it has become a real partnership. Then we started to get a huge focus on the amount of time it takes to get a charge posted. Because we were still paper-based with notes in the hospital, my coding team would follow the charts around and instruct everything to our physicians. That involved a huge amount of manpower and time. There were too many conversations about it taking too long to get charges in, and why charges were missed.” Now, England says, they aren’t chasing charges, but instead they are helping the physician understand the best and most appropriate way to capture their charges, and then the dollars can be captured after that.

STRATEGIC CHALLENGES

A recent survey of 300 hospitals by the Healthcare Financial Management Association (HFMA) indicated declines in patient revenue and cash on hand. Healthcare organizations must implement strategies to increase cash, such as business office improvement, front-end collections, reduction in aged AR, denials management, and outsourcing to improve self-pay collections, say industry experts.

According to William Hasselbarth, executive vice president and CFO at Albany Medical Center, preparing strategically as well as operationally for health reform and the characteristics that they knew were part of health reform was a huge challenge and something that was crucial to their RCM success. “Strategically, we identified a number of corporate strategies that we would deploy around preparing for the new world (so to speak) of reform and what that entails; but also on the operational side, we knew there were going to be revenue pressures, expense profile pressures, demand for efficiency, and accountability to justify our cost, so we undertook an operational review, identifying areas where we looked at performance improvement,” he says.

William Hasselbarth

One of those areas was revenue cycle, and stemming from that, Albany Medical Center was able to identify plenty of recommendations on how it could implement best practices. “It goes all the way from making sure our clinical documentation is robust to capturing every last clinical indicator and making sure we’re capturing all of that from coding standpoint and revenue standpoint,” he says. “But it was also around denial management, revenue capture, identification and charge capture, AR management, how quickly it takes a bill to go out, how clean those bills are when they go out the door, and the cost to collect. We have a whole list, and we’re making sure we track and optimize our performance around all of those revenue cycle areas.”

One of the big things related to system change was the cultural shift in terms of how revenue cycle operations were conducted, adds Veronica Ziac, director of information technology at Ellis. “The system drove some of those changes—previously we had a lot of fixes going on at back end. For instance, the business office would adjust charges and would change things on a visit to produce clean bills, but a lot of those problems were caused by front end staff (registration error or charge error), and it all ended up back in the business office. It was a poor model, it was hard to manage, and it did not put the right work to the right person at the right time.” The way the system works now, Ziac continues, is that it pushes much of the responsibility to the right place, so you can fix your own errors. “That’s been a huge shift for us, in thinking and in culture; and we have added staff up front to handle those workloads.”

Ziac admits that RCM becomes more challenging every single day. “More recently, one example is the increase in high deductible plans. That is something we have now started to understand the implications of, as we are seeing a downturn in some of our volumes for voluntary admissions and procedures. People are putting off care because they have to pay out of pocket. How do you mitigate that? Your volumes are down but these are people who need service. How do you work that in your business plan?”