A new CHIME case study illustrates the wide impact of IT in facilitating business office improvement.

Billing patients for healthcare services is an intricate process, with charges likely to come from any professional who provided services, and patients are often surprised by the complexities and multiplicity of bills.

Maine Medical Center and other Portland-area MaineHealth providers recently began offering patients a unified single bill showing consolidated charges from providers within the integrated delivery system. Grouping all charges on one patient bill required significant background work and coordination between provider organizations in MaineHealth.

MaineHealth’s experience is the subject of a new case study in .pdf format published by the College of Healthcare Information Management Executives (CHIME) that demonstrates many of the hurdles awaiting diversified healthcare organizations that want to improve billing practices. MaineHealth's billing initiative exemplifies high-profile efforts in the healthcare industry to help patients and their families more easily understand healthcare’s complex system of charges, insurance payments and patient obligations.

MaineHealth encompasses eight diverse hospitals, ranging from the state’s largest tertiary care center to small critical-access hospitals in sparsely populated areas. The system is transitioning from being loosely affiliated to more tightly integrated, and IT is one of the key components aiding in that transition, says Barry Blumenfeld, CIO at Maine Medical Center, as well as for the system as a whole.

MaineHealth is in the process of implementing a single patient record throughout the system. That initiative took a big step forward on December 1, 2012, when Maine Medical Center and other care providers in the Portland area switched over to an integrated hospital information system from Epic Systems Corp. As part of that implementation, MaineHealth decided to implement a module of the system to offer a single billing office (SBO) that could generate one bill for all network services.

For patients, an SBO has the potential to submit a single, understandable, itemized bill that contains all charges for all providers within MaineHealth. Consumers have one telephone number that is a point of contact for all billing questions, and the MaineHealth customer service personnel on the other end of that call have access to information to answer all questions. And with one bill, consumers are able to write one check to cover their obligation for medical care.

Changing the billing approach of an integrated delivery system, in which providers had traditionally billed individually for services, forced decisions to be made on several levels, Blumenfeld says, and not all of them had to do with information technology.

The stakes are high when an organization changes its billing approach; for MaineHealth, implementing the SBO carried the risk of seriously impacting the system’s ability to issue bills, which could reduce the flow of payments and increase the length of time it waits for cash, measured by days in accounts receivable.

“When you go to a single patient statement, it forces us to be consistent in a wide variety of practices,” says Mike Kasabian, director of business applications for MaineHealth, who’s in charge of aspects of the implementation that affect the revenue cycle, scheduling, registration, billing and health information management. “It got us to look into things like health information management (HIM) policies, the need for a consistent free care policy, collection and bad debt policies, and more. You have to think about the whole MaineHealth system upfront, and this has forced a lot of business change organizationally.”

“MaineHealth IT Works to Improve Consumer Experience via Centralized Billing,” is the third in a series of case studies by CHIME that highlights the benefits and best practices of successful implementations of information technology. To access the full case study, visit http://www.cio-chime.org/chime/press/CaseStudy/MaineHealth_Case_Study.pdf.

Source: CHIME


The College of Healthcare Information Management Executives (CHIME) is an executive organization dedicated to serving chief information officers and other senior healthcare IT leaders. For more information, please visit www.cio-chime.org.