Recovering Buried Revenue Potential

Decreasing the number of unbilled days, or the time it takes to generate and mail a bill and get it into the hands of a discharged patient, by just several days can reduce a hospital’s weekly cost of unrealized revenue from delayed payments by millions of dollars. That’s the kind of bottom-line fact that cannot be ignored as healthcare providers continuously strive for financial security.

Stuck in Coding Limbo
Concord Hospital, a regional medical center based in Concord, N.H., is the second busiest acute care hospital in New Hampshire, with 205 licensed beds and more than 15,000 admissions in 2004. It provides traditional acute care services in 50 medical specialties and subspecialties, and offers individual centers dedicated to cancer, trauma, orthopedics, cardiology and urgent care.

SOURCE
Dottie Poudrier
Coding Manager
Concord Hospital
Concord, N.H.

PRODUCT/COMPANY
eCopy
eCopy Inc.
Nashua, N.H.
www.ecopy.com

Last year, Concord Hospital’s Walk-in Urgent Care Center was in urgent need of three additional coders to prepare and process invoices. Like many healthcare providers, Concord Hospital had always relied on paper-based patient invoices and records to drive the billing process, but mounting cost pressures and compliance with federal regulations such as HIPAA forced the medical center to seek out a better coding method.

According to Concord Hospital’s coding manager, Dottie Poudrier, her department could not keep up with the backlog of paper claims waiting to be coded because of a lack of staff. There was a limited supply of coders looking for jobs, and enticing new hires was an issue, since most candidates wanted to work from their homes. “We needed to offer something special as an incentive to make coders jump ship, since most of them generally stay in one place,” she says.

Poudrier’s goal was to facilitate the hiring of more coders that would ultimately shave two days off Concord Hospital’s average number of unbilled days, which was 14. The problem, though, was clear: How do you keep patient records secure and adhere to HIPAA’s strict requirements while attracting quality coders who require the freedom to work at home?

Expediting the Workflow
In addition to addressing the coding staff shortage, Poudrier and her team aspired to eliminate paper completely from the billing process. With this in mind, they mapped out a plan to move to a data entry solution through specialized network devices and customized electronic forms processed by Concord Hospital’s mainframe system. To accomplish this, the medical center needed a method of converting existing paper records into electronic documents while the hospital’s infrastructure and applications were being revamped.

The remote coders were committed to learning the new process because of
the benefits and flexibility of being
able to work from home.

As an initial step in 2004, Poudrier upgraded the department’s photocopier to a digital Canon imageRUNNER equipped with eCopy software from Nashua, N.H.-based eCopy Inc. In the fall of 2004, her staff began scanning paper generated by the Urgent Care Center into the department’s computer system. The new process required minimal training. In four hours, the staff learned to scan emergency room records and ancillary claims, including laboratory results, and assign them to a secure network folder that both on-site and off-site coders could access through a virtual private network (VPN).

This procedural evolution allowed Poudrier to entice prospective coders with the option of working remotely; she hired the three at-home coders that she needed. Training them, installing and configuring additional PCs, and setting up VPN access took approximately three months, however. “Coder training and scanning training were minimal. It generally took the remote coders about a week to get comfortable,” Poudrier says. Best of all, the remote coders were committed to learning the new process because of the benefits and flexibility of being able to work from home.

Remote Coders to the Rescue
The document management software, coupled with the high-speed scanning capabilities of a digital copier, enabled Concord Hospital to convert paper documents into electronic information that was easily integrated into commonly used business applications, including the existing Novell GroupWise collaboration and communications system and other networked enterprise applications. The result was low-cost, easy and instantaneous distribution and management of electronic copies of paper documents.

Concord Hospital’s coding department has experienced an almost 60 percent decrease in the average number of unbilled days, from 14 days to 8 days … [and] reduced its weekly cost of unbilled days by an average of about $3.6 million.

Using the new software allowed Concord Hospital to offer a digital document workflow that could accommodate teleworkers. The at-home coders who Poudrier hired have been 25 percent more productive than those coders who work in-house, she says. Overall, Concord Hospital’s coding department has experienced an almost 50 percent decrease in the average number of unbilled days, from 14 days to 8 days. No one anticipated the results would be so dramatic, particularly not the medical center’s administrative department. By hiring the at-home coders and decreasing the number of unbilled days, Concord Hospital reduced its weekly cost of unbilled days by an average of about $3.6 million, according to Poudrier.

The medical center “locked down” the desktop computers that it supplied to its remote coders by restricting access to its network’s multiple shared drives and folders, as well as file and print servers. Limiting access to patient information for the at-home coders helped Concord Hospital to comply with HIPAA by eliminating concerns regarding the security and confidentiality of patient records.

Poudrier’s team plans to achieve its original goal of implementing a fully electronic records and billing system by the end of this year. In the meantime, the eCopy software has proved to be both convenient and productive not only for Concord Hospital’s coding department, but also its health information department.