matically accelerate payments and more effectively manage their fi nancial operations.
While some organizations select tools that lack critical features or functions, others opt for full-service solutions but fail to fully utilize and manage the functionality of the system. For example, billing systems that have features such as date and time-stamp tracking are a necessity because they allow providers to manage and monitor workfl ow and revenue in real time. Without enabling this function, provid- ers cannot accurately document when patients schedule an appointment, when they check in, when insurance is verifi ed, when co-payments are collected, when charges are entered, when payers and patients are billed and when payments are received and posted.
One way for organizations to determine if they are using systems correctly or need to replace or upgrade them is to closely assess and document the capabilities of every appli- cation and the functions they actually are using within each system. As providers implement or upgrade their EHR sys- tems, they should consider what implications these systems will have on the revenue cycle and look for the most robust and fully integrated solution. For instance, ICD-10 will have a huge impact on coders and physician documentation, meaning organizations will have to educate and train both coders and physicians to ensure accurate and timely billing. Additionally, providers need to evaluate if it’s in the best interest of their organization to implement other technol- ogy solutions to help them streamline front-offi ce and RCM operations. For example, tools – such as patient portals and patient kiosks – enable patients to self-register for appoint- ments, update their insurance and demographic information and pay co-payments/co-insurance online, either prior to the visit or at the point of care.
Studying personnel and workfl ow In addition to a review of fi nancial metrics and technology, a comprehensive assessment requires organizations to inter- view and observe staff to map out the workfl ow impacting the entire revenue cycle. It is essential that the assessment includes all constituencies touching the revenue cycle – from front offi ce and billing staff, through clinicians, third-party vendors, fi nancial analysts and managers. These interviews, layered with critical on-site observations, will give organiza- tions invaluable insight by identifying and recommending opportunities for improvement. Two areas that are likely in need of addressing are effort duplication and the transition from manual to more automated workfl ows. An example of duplication of effort is when both a sched- uler and a central business offi ce employee separately verify insurance for the same patient. By assigning the task to a single person and closely managing the results, providers will increase employee productivity and streamline workfl ow. As hospitals and medical groups transition away from manual processes and implement more automated workfl ows,
they are looking to identify and reduce the prevalence of repetitive tasks. A prime target for automation is work as- signment, which historically has been accomplished verbally or via printed AR reports, and can now be routed electroni- cally to employees through detailed work lists available at the start of their shifts. Organizations can also implement computer-assisted coding (CAC) software to help coders and health information management (HIM) employees meet increased workload demands from ICD-10, which will boost the number of procedure and diagnosis codes from 16,000 to approximately 155,000 codes. CAC software automatically generates codes from electronic physician documentation for coder review and validation, therefore signifi cantly decreas- ing the time and effort required by the staff when manual processes are in place.
Road map to success The fi nal stage of the fi nancial and operational assess- ment involves the development of a road map for action and remediation based on fi ndings. This strategic plan will specify processes, technology systems and job responsibilities of personnel across the revenue cycle. While the road map will vary from hospital to hospital and practice to practice, it should include an educational, communication and outreach plan for employees and physicians.
It is crucial that physicians and registration, billing, coding and HIM employees understand how their roles affect the revenue cycle and, ultimately, contribute to their organiza- tion’s fi nancial health.
Hospital and medical group leadership will also need to clearly demonstrate their commitment to the road map. They can do this by having senior executive management and revenue cycle department directors join project managers to help drive meetings, provide regular updates and quickly address concerns from employees. The process of overhauling the revenue cycle can be chal- lenging because it often involves dramatic changes in culture and workfl ow. But organizations that work proactively and methodically to improve revenue cycle operations from top to bottom will be in the position to accelerate cash fl ow, reallocate FTEs, decrease costs, boost productivity, leverage cutting-edge technology and gain a competitive advantage that will sustain them through the ever-changing dynamics of today’s healthcare industry.
HMT HEALTH MANAGEMENT TECHNOLOGY May 2012 7