Because the system is online, users have access to a centralized repository of billing and claim information. System updates are totally automated and available in real time with little or no staff intervention.
a total of fi ve full-time staff members, Moore was able to reallocate 3.5 FTEs away from the day-to-day processing of primary and secondary claims. These staff members now follow up on delayed payments from payers and handle rejected claims.
• Executive dashboard capabilities: As revenue cycle director, Moore’s favorite feature within RCM is the executive dashboard, which she views daily and uses on a weekly basis to create executive reports. At any time, Moore can see how much has been billed, what is on hold, and when payments are expected. “System reporting is defi nitely my favorite part of the system,” she mentions. “I can inform my CFO of dollars expected from each payer on specifi c dates.” This capability has helped the organization to accu- rately forecast revenue and predict cash fl ow. Staff members can also see which claims are being held, for what reason, and the specifi c dollar amount, with drill-down capability to view claim details.
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.
According to Moore, HealthPort RCM has been a life-saver in four specifi c areas: integrated 3M compli- ance tools, fl exibility to override codes, ease of use and executive dashboard capabilities. • Integrated 3M compliance: HealthPort RCM includes 3M’s editing and compliance software to provide cod- ers with both OCE and LMRP edits. Moore’s prior revenue technology vendor did not provide these edits and therefore, a high volume of claims were being denied.
• Flexibility to override codes: There are times when Moore’s certifi ed coders have a difference of opinion about a particular edit or code. In these situations, the system gives Moore and her team the ability to override and edit claims easily – a capability that in conjunction with the integrated 3M software has led to cleaner claims. In the past, 90 percent of claims failed edits. Now, more than 90 percent of claims are completely clean.
• Ease of use: According to Moore, the learning curve was about one month with all staff very comfortable within eight to 12 weeks. System navigation is intui- tive and walks billing staff through the process. As a result, staff is more effi cient and productive. With
• AR days reduced by 34 days • Over 90 percent clean claim rate • 70 percent of staff reallocated • Eliminated back-end denials • Real-time data for contract negotiations
Since the installation of the RCM solution, “only a few claims error-out and our error rate is rarely over 5 percent on any day,” Moore states. At the acute care facility, Watauga Medical Center, AR days have fallen from the high 70s to the low 40s on average. While Moore does not have exact “before” fi gures, she has seen a dramatic reduction in back-end denials – such as those associated with failed edits. Furthermore, RCM handles the reimbursement differences of ARHS’s two critical-access hospitals.
All remittances come back electronically through RCM for the payers who participate. The organization’s HIS did handle a few ERAs electronically, but with RCM many more payers can send them online. At any time, Moore and her team can see the status of Medicare claims, compare payers and extract real-time data to help with managed care contract negotiations. When asked what she would change about RCM, Moore says she would like the ability to see real-time status of claims for more payers than just Medicare. Her wish will have to wait until more payers open their doors to revenue cycle management solutions. Payer participation in real-time claims status reporting is beyond the privy of HealthPort or ARHS, at least for now.
HMT HEALTH MANAGEMENT TECHNOLOGY July 2010 17