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Claims and coding


Rural healthcare system drops AR days and cleans up claims


RCM system has led to dramatic reductions in AR days, denied claims, and billing backlogs while supporting the organization’s move to a new central business offi ce.


hen the Appalachian Regional Healthcare System (ARHS) was formed in 2004, the organization’s vision was to build a regional healthcare system that enhanced quality of life and resulted in healthier individuals. Like- wise, Rayanna Moore, BSHM, MSOM, system director of revenue cycle, had a mission when she joined the organization in early 2008. Moore’s goal was to enhance revenue cycle operations and create a healthier bottom line for ARHS. To accomplish her objective, Moore quickly identifi ed three important initiatives: centralize business-offi ce func- tions, reduce accounts receivables (AR) days and clean up billing claims. She turned to HealthPort’s revenue cycle management (RCM) system. Today, HealthPort RCM is installed at all three hospital locations. The system has led to dramatic reductions in AR days, denied claims, and billing backlogs while supporting the organization’s move to a new central business offi ce.


W At a glance:


Appalachian Regional Healthcare System, Boone, North Carolina


Facilities: • Three hospitals across High Country • 117-bed acute-care hospital • Two 25-bed critical-access hospitals • Long-term care and physician practices


For decades, North Carolina’s High Country healthcare was provided by three unique and independent hospitals – Blowing Rock Hospital in Blowing Rock, Charles A. Cannon Jr. Memorial Hospital in Linville and Watauga Medical Center in Boone. In recent years, the hospitals have forged relationships with one another not only to expand the services offered, but to enhance the quality of care as well.


In 2004 two of the hospitals joined to form the Appalachian Regional Healthcare System (ARHS) and the third hospital, Blowing Rock, was added in June 2007.


16 July 2010 Challenge


When Moore arrived on the scene, she immediately faced a revenue cycle crisis. AR days were hovering in the high 70s and more than 90 percent of claims couldn’t pass the fi rst round of edits. There was an abundance of back-end claim denials and the staff was sorely lack- ing time for claim cleanup. From an organizational perspec- tive, each of the three hospitals managed their own business offi ce technology, processes and staff. Reporting tools available within the


Rayanna Moore, BSHM, MSOM, is system director of revenue cycle for Appalachian Regional Healthcare System.


RayannaMoore


legacy revenue cycle system were obsolete and lacked any type of dashboard capabilities. And fi nally, only minimal data was available to support managed care contracting. Moore’s fi rst action plan focused on evaluating current systems and identifying where the process breakdown was occurring. The core hospital information system (HIS) was fi rst in line. Moore discovered that many of the billing rules within the HIS had not been properly defi ned. With the HIS billing rules brought up to date, attention was turned to the third party claims scrub- ber. It was here that Moore found her greatest challenge


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– and biggest opportunity for improvement. System analysis revealed that the third-party scrub- ber wasn’t scrubbing anything. More than 90 percent of claims were dirty and couldn’t pass the fi rst round of edits. In addition, the system required extensive maintenance to load updates and keep current. It was at this time that Moore decided to evaluate other claims scrubbers and revenue management technologies.


Solutions With a clear directive to centralize business-offi ce functions while reducing the total cost of ownership for revenue management technology, Moore decided to take a closer look at HealthPort’s Web-based solution.


HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com


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