Revenue Cycle Management – Web Special

Aug. 31, 2009

Grease the Wheels of Your Revenue Cycle Using Workflow Automation

Automating five key areas of the revenue cycle can significantly impact financial operations by getting clean, actionable information into the cycle faster.

By Margaret Mayer

The financial life of a hospital is tied to the smooth operation of its revenue cycle. Each stage of this financial ‘life cycle’ needs to operate as smoothly and accurately as possible. By automating the manual workflows that slow progress and introduce inaccuracies, hospitals are experiencing faster revenue, reduced denials, a more efficient workforce and greater customer satisfaction.

Hospital management is often unaware of the amount of repetitive manual work that is done in the business office, and is surprised by the resource and monetary savings they realize by automating even simple tasks. Following, are five key areas of the revenue cycle: patient access, clinical management, claims payment and management, patient billing and payment, and denials management. In each of these areas, automation can significantly impact financial operations by generating clean, actionable information faster into the revenue cycle.

While there are literally thousands of tasks that may be automated within the revenue cycle, here are examples of how automation is playing a significant role in recovering revenue or accelerating the revenue cycle:

Patient Access – Make sure all patient data is accurate. Many hospitals are now using clearing houses, or have developed a system for automatically checking insurance eligibility at the point of registration, and are feeding this valuable data to the hospital information system (HIS). One hospital in California is using automation technology to take patient Medicare billing information as provided by the patient and checking it against information in the Medicare screens to identify potential problems with Name, Gender, DOB, Secondary Insurance and other demographic information. An exception report is automatically generated that flags issues requiring manual intervention. This project has lead to a savings of roughly 10 hours per day and $1.2 million each year.

Clinical Management – Get your departmental systems in sync with your financial systems. Unlike hospital billing, physician billing is transaction-based. Adding to the difficulty of cash posting in this environment is the possibility that contracts for hospitals and insurance companies may change every year. Correct patient co-pay on the account is critical to patient satisfaction when statements are distributed. On the management side, timely and appropriate adjustments are crucial in terms of revenue cycle management and accounts receivable (A/R) days.

When Halifax Health in Halifax, Fla., began using the LSS Physician Billing & Receivables module in conjunction with Meditech, the goal was to manage the physician billing from within the patient billing and financial services area, including automating posting adjustments. Since contracts change frequently, it was important to ensure that maintenance would not hinder effectiveness. As a result, the department used scripting technology to completely automate the adjustment process and accommodate the changing demand for patient co-pay responsibility.

The automated process uses an Excel spreadsheet to determine appropriate co-pays, which any of the supervisors can modify whenever the rates change. Halifax Health is running LSS with approximately 25 physician practices or departments. By automating physician billing adjustments, Halifax has saved the hospital approximately one eight-hour day per week from a posting representative. Without this automated process and the increased business, those hours could have risen significantly. The staff now has more time to post actual cash and analyze underpayments, which is more productive.

Claims Payment and Management – Manage and track the status of your claims. Coffee Health Group in northwest Alabama uses workflow automation throughout its three main facilities to generate billing files and patient care reports, and manage many departmental reporting processes. The business office realized that the hospital was losing potential revenue from the emergency department (ED) based on a problem with coding nursing assessments. Since there was no designated employee entering the codes for the emergency department, the codes for the thousands of nursing assessments that occur at the hospital each day were often done improperly. This cost the hospital staff valuable time and the hospital lost revenue. Additionally, patient charges need to be posted on the same day for correct billing, resulting in billing delays and inaccuracies.

In response, a spreadsheet of the billing codes for the ED nursing assessments is automatically generated and each assessment is automatically posted every night, with a valid time stamp. Automating this process ensures that a complete, accurate batch posts each night, guaranteeing the billing cycle and maintaining steady and accurate revenue flow. Automation has greatly simplified a process that would have required two full-time employees manually entering billing codes. In addition to reallocating resources where they are most needed, Coffee estimates it has generated about $30,000 of new revenue each month from missed or delayed postings.

Patient Billing and Payment – Replace collection calls and bad debt with prompt payment. One affect of the downturn in the economy is the increase in uninsured patients and bad debt. Helping patients understand their costs up front is a huge step in the collection process. At Coffee Health Group, each night reports are automatically generated that create an individual collection letter for each patient scheduled for treatment the following day. The letters are printed out in three different office locations allowing financial personnel to work directly with the patient by providing an upfront estimated amount that the patient will need to pay.

Denials Management – Automate remittance advice, increase acceptance and improve collection. Phoebe Putney Memorial Hospital in Albany, Georgia is accelerating the recovery of millions of dollars in claims, reducing days in A/R and consistently reducing its failed claims amount by as much as 86 percent. The business office is using scripting technology to generate, review and clean failed claims reports. A clean report is automatically e-mailed to billers with claims marked as either “released from failed status” or marked as an “exception” that needs human attention. Phoebe Putney is processing 300 claims per hour and the hospital doesn’t need to hire additional full-time employees or pull other resources to help manage the failed claims report.

Take a mental walk through your revenue cycle. Where are people doing a lot of data entry or typing? Where are they typing something that has already been typed? Is what they are doing an efficient use of their time? If their workflow is fairly easy to explain in an instruction manual format or may require decision making but the decisions are not “experience based,” then those processes are very good candidates for automation and they will likely help you recover the revenue you’re due. They might simply be the squeaks in your revenue cycle that could use a little grease.

For more information on
Boston Software Systems,

Margaret Mayer is director, Boston Software Systems.

Sponsored Recommendations

Patient Engagement and ML/AI – Modern Interoperability as an enabler for value based care

Discover how modern interoperability empowers patient engagement and leverages ML/AI for better outcomes in value-based care. Join us on June 18th to learn how seamless data integration...

New Research: The State of Healthcare Cloud Security and Compliance Posture

Compliance & Security Debt Awareness Could Have Prevented Change Healthcare & Ascension Healthcare Breaches

Telehealth: Moving Forward Into the Future

Register now to explore two insightful sessions that delve into the transformative potential of telehealth and virtual care management solutions.

Telehealth: Moving Forward Into the Future

Register now to explore two insightful sessions that delve into the transformative potential of telehealth and virtual care management solutions.