Work-fl ow Management
major processes was complete within six months. Rules were built online that mirrored the hospital’s policies, mitigating compliance issues. Built-in proto- cols ensured that policies were enforced without ex- ception, because the system controls when and where a request is moved. In the case of a staff workaround, administrators can turn to the electronic work fl ow for an audit of where the infraction occurred. Vendor and hospital staff worked to create administrative forms within the system, eliminating the need for preprinted and often inconsistent forms. This is a change that also holds promise for clinical forms, be- cause patient safety can be ensured further with consistent information and automatic fi lling of redundant patient information.
Upon implementation, administrative staff saw bottlenecks dissolve and decision speed increase as human resources documents, risk management documents, requisitions and capital- purchase documents were tracked instantly to elec- tronic desktops. One feature of note is intelligent forms, which sends alerts to process managers after 48 hours of holdup.
tive ii According to a study by
PriceWaterhouseCoopers, the average cost to process an invoice manually is $1.26, compared to an electronic invoice at 36 cents – a cost differential of 90 cents per invoice.
RAC: a way to fi ght back In response to fi nancial and regulatory pressures, the hospital’s work-fl ow solution also has recovery audit contractor (RAC) functionality that, should the hospital be audited, will set a work fl ow in place to notify necessary staff members and track the appeal progression, thus ensuring deadlines will be met. The RAC program is substantially tougher than any previous Medicare program designed to recover excess reimbursement from Medicare providers. Of the problems identifi ed by RACs between 2006 and 2008, approximately 96 percent (i.e., $992.7 million) were overpayments, while the remaining 4 percent (i.e. $37.8 million) were underpayments (subsequently disbursed to providers). These statistics should offer
32 October 2010
enough motivation for hospitals to prepare for an audit before it happens – because it likely will. The RAC solution took slightly longer to implement at Doctors Hospital than other work-fl ow processes. A potential RAC audit must be appealed within a limited amount of time and review, and a signifi cant volume of information is needed to accommodate an audit request, so the RAC work fl ow necessitates a multi-faceted setup that can accom- modate the speed, detail and volume of information that an audit requires. The revenue management depart- ment now has a dashboard view for the complex work fl ow, color coded for importance and displaying total dollar amounts.
reques a m m
Instead of dedicating signifi cant staff labor to respond to an RAC audit request, which under normal circum- stances could require the retrieval and preparation of 200 records per 45 days, staff can trace and gather claims and records through an electronic work fl ow. This functionality requires a fraction of the time demanded by a manual audit response.
The revenue cycle department is also able to run reports to examine the issues identifi ed in a RAC audit. Through these proactive analytical capabilities, the department has found that contractors made errors in their reporting and auditing of hospital records. Results of the RAC work-fl ow solution have been
excellent; since the system has been operational, the hospital has not lost a single RAC appeal.
Results of automation Doctors Hospital has tackled its administrative
work fl ows with resounding success. Through care- ful on- and off-site coaching from vendor staff, and a commitment from both administrative and clinical per- sonnel, the hospital has been able to realize signifi cant returns. By eliminating numerous paper-based work fl ows and creating an accountable electronic routing system, the organization has reduced unnecessary administrative staff time and costs associated with printed forms and increased compliance with policies and regulations. Currently, the hospital has numerous work fl ows in place, including those for the human resources, revenue cycle management, purchasing and account- ing departments. Administration at Doctors Hospital expects to automate several additional processes within the next few months and plans to integrate the work-fl ow solution with its new EHR system to handle clinical work fl ows.
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