To control costs and improve results, many medical groups are evaluating a new generation of revenue cycle management (RCM) solutions. When providers mismanage the revenue cycle, the financial impact may seem fairly small on an individual claim, but when multiplied by hundreds of visits a week, the effect on the bottom line can be devastating. Ultimately, a good RCM solution enables a patient care organization to spend less time on billing and more time providing quality patient care.
Healthcare organizations that are looking for help with their RCM need to consider several factors when choosing the right vendor, and that timeframe of deliberation was not lost on Karen England, CPC, revenue cycle administrator and assistant director of revenue cycle operations at Atlanta-based Emory Healthcare. Overall, Emory is the largest healthcare system in Georgia, encompassing six hospital-based clinics and more than 60 physician group practices throughout metro Atlanta and Georgia.
England works on the physician side, supporting the entire physician billing and accounts receivable (AR) for Emory’s internal medicine, hospitalist group, and critical care group, in addition to other specialty groups. England oversees all the teams that deal with coding, billing and reimbursement for those areas, and was thus a central part of the process that partnered Emory with Ingenious Med, an RCM vendor also based in Atlanta. England spoke with HCI Assistant Editor Rajiv Leventhal about RCM in an integrated health system, partnering with Ingenious Med, and key factors to be aware of when choosing an RCM vendor. Below are excerpts from that interview.
In an integrated healthcare system such as Emory, does the role of RCM administrator become more complicated?
We are—as most health systems are doing now—acquiring practices and joint venturing with other hospitals. We currently have six facilities underneath the Emory umbrella. It gets challenging because until those new acquisitions are on our electronic medical record (EMR) or our operating systems, you’re kind of working with different mechanisms, especially in terms of capture codes. When we need medical records for coding or billing, it’s a big problem because in some cases they are electronic, but we don’t have access to that system right away. We’ve also had instances where the hospital is still on paper. Until they are fully integrated on Emory’s electronic systems, I can’t get a patient’s information, registration information, or census information as automatically or easily as I do within our integrated systems. It’s hard to know about the charges, and it’s hard to code them.
What was involved in the process of becoming an Ingenious Med customer and how are you now reaping the benefits?
We started out using Ingenious Med’s solutions in our hospitalist group; our hospitalists have long used them. Then, starting about five years ago, I would be involved in daily debates with my pulmonologist group, who would complain that we weren’t getting their charges, or we were coding something wrong, or we were late with everything, so we then knew we needed to make changes. When we did switch to Ingenious Med, we saw immediate turnaround in capture time. We also saw a $20,000 improvement in bill charges a month, just in things we didn’t know about or didn’t know what to look for in the chart. We were still paper-based at the time and we knew where to look for notes, but maybe something was filed wrong or referenced in a way that we didn’t know how to get it.
The biggest benefit there is that the physician knows what he/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. So I made a proposal that if we moved all of our specialty areas to Ingenious Med’s solution, what will it look like? We decided to implement one specialty area at a time. And thankfully, we were able to redeploy employees to other areas. We weren’t chasing charges, but instead we were helping the physician understand the best and most appropriate way to capture their charges, and then we could capture the dollars after that. As our departments grew, we didn’t have to add full-time employees for things like charge entry and coding, and that was a huge win for us.
What are some of the most pressing issues you experience in RCM?
We see denied claims and we have a claims editing system. But we do not have a great way to see claims that just go out and sit in never-never land with no activity on them at all. We can be top notch on our denials and claim edits but we could still not be maximizing the reimbursement side. That’s a challenge. Also when we work our claims denials, we don’t have a good mechanism to prevent something from being worked three or four times. A claim might be paid already, for example, but we don’t see it. We sometimes work the same thing over and over. That is a lot of how our internal systems are set up now. But we are always looking to modify and catch we don’t see.
What are some revenue cycle trends you are noticing and how is Emory keeping up with them?
Well, ICD-10 is huge. We’re working with a team within our information systems that is working on ICD-10 preparation. I would say that we’re halfway there now. And part of that involves going to Ingenoius Med and our other vendors and asking, “Will you be ready for ICD-10?” Ingenious Med has impressed us in that they are the furthest along of all the vendors we use, and a big part of that is their enhancements with diagnosis searches. We have been getting feedback from physicians that it’s a huge improvement as previously, they weren’t able to find anything. I can pull diagnoses all day, but they’re the main ones using the tool. If they can’t find what they need, they won’t use it.
What are some pieces of advice you can offer other health systems when looking for an RCM partner?
Trust in your vendors is definitely big. Also, looking at a company’s track record from other clients is also important as you go through the process. One of the biggest lessons learned is that it helps to see what information systems communicate with each other. We often hear from physicians that they are in the EMR all day long, but it doesn’t talk to Ingenious Med. We have to do some work around that to help them because we don’t want them to worry about that and wonder if they have every patient on their list or think about what type of insurance their patients have. We had a point where our doctors were very overwhelmed because a lot of systems didn’t talk to each other. The functionality between applications is very important.