Technology and a Strong Patient Focus Help Providers Excel in Revenue Cycle Performance

Regardless of the size or scope of their organizations, all revenue cycle leaders can learn from solutions shared by the winners of the 2018 MAP Award for High Performance in Revenue Cycle.

The push to improve the patient experience is reshaping the revenue cycle—just ask the winners of HFMA’s 2018 MAP Award for High Performance in Revenue Cycle. Boosted by new revenue cycle technology—from simple dashboards to artificial intelligence (AI) robots—this year’s MAP Award winners demonstrate a strong commitment to promoting greater efficiency and improving patient access and convenience. The following tips for achieving exemplary performance, based on practical ideas shared by this year’s MAP Award winners, are applicable to organizations of every size.

Focusing on the Patient Experience

The connection between patient-centered practices and strong revenue cycle performance is illustrated in approaches from three of this year’s winning organizations.

OhioHealth: Standardize, simplify, and centralize the patient experience. OhioHealth in Columbus, Ohio, continues to focus on standardizing and simplifying the patient experience across the revenue cycle. “Taking the friction out of the patient experience is our goal,” says Margaret Schuler, system vice president of revenue cycle. In 2015, the health system rolled out a new electronic health record (EHR) to seven of its hospitals and to all its physician practices, urgent care clinics, and hospice and home health agencies. OhioHealth used this opportunity to develop a guarantor patient statement that allows patients to see all their patient liability balances on one statement, instead of receiving separate statements from each facility and provider, with different account numbers.

OhioHealth also has centralized its customer service collection team and processes As part of this effort, it has established one phone number to contact a representative; expanded usage of IVR (interactive voice response) functionality, including bill pay and information requests; and established a “price hotline” for consumers shopping for services. To create a more consistent patient experience, OhioHealth also offers online bill pay for all its hospitals, including three facilities that remain on disparate EHRs.

“Even if patients go to a facility that is not on our standard EHR, they can see all of their balances in one place,” Schuler says.

Murray-Calloway County Hospital: Make better patient financial communications a priority. The advent of high-deductible health plans (HDHPs) has spurred the need for better patient financial communications at many organizations. At Murray-Calloway County Hospital in Murray, Ky., leaders aimed to improve the patient experience by alleviating the “sticker shock” that patients with HDHPs often received on receiving their bills. “We wanted to educate the patient on what the new expectation was in health care for patient payment,” says David Ralston, executive director of revenue cycle and operations.

The hospital participates in HFMA’s Patient Financial Communications Adopter recognition program, which is required to earn HFMA’s MAP Award for High Performance in Revenue Cycle (hfma.org/communications). Ralston says this program provided the framework for his hospital’s new patient financial communications approach. His team also formed strong relationships with vendors who shared their goals for improving patient financial communications.

Geisinger: Analyze patient interactions for ideas to build a more patient-centered culture. Top-performing revenue cycle departments use patient feedback to improve the patient experience. At Geisinger in Danville, Pa., call center representatives use a customer relations management application in the EHR to log and categorize patient interactions. By monitoring patient feedback, leaders discover opportunities to improve the patient experience. For example, they scripted easy-to-understand explanations that call center representatives can use to answer patients’ common billing questions. They also wrote a service recovery policy that allows call center staff to provide one-time discounts or adjustments to conciliate dissatisfied patients and build customer loyalty.

Harnessing the Power of Technology

Organizations are investing in a variety of tools to improve their revenue cycle performance. Finance leaders can take away valuable ideas from eight award winners that have demonstrated excellence in leveraging new technology.

Princeton Baptist Medical Center: Implement front-end technology that cuts wait times for patients in the emergency department (ED). Birmingham, Ala.-based Princeton Baptist Medical Center allows patients with non-life-threatening conditions to check into the ED online using an app—giving them the ability to wait at home until ED staff are available to see them.

Privia Medical Group: Leverage the patient portal. Many MAP Award winners are making the most of their investments in patient portals. Privia Medical Group in Arlington, Va., offers a robust patient portal used by up to 65 percent of patients within three months of their visits. Privia also provides an online scheduling tool for patients to book appointments online without logging into the portal. New patients can complete their forms and provide demographic information online, accelerating their check-in process in the office.

CHRISTUS Mother Frances Hospital—Tyler: Take the bumps out of admissions. Spurred by comments on patient satisfaction surveys, admissions leaders at CHRISTUS Mother Frances Hospital in Tyler, Texas, now use their EHR’s reporting functions to track patients’ wait times through “crucial moments” in their service experience, including at various points during admission. These data are compiled into a color-coded dashboard in the EHR that refreshes every five minutes, allowing leaders to see patient throughput in real time. Wait times beyond 15 minutes are coded red so leaders can float available personnel to affected areas quickly to address potential bottlenecks.

St. Elizabeth Healthcare: Use tools that verify eligibility and benefits in real time. MAP Award winners are utilizing technology to improve efficiency and promote better price transparency. St. Elizabeth Healthcare in Edgewood, Ky., uses an online tool that offers real-time electronic verification of eligibility and provides staff with details on patient deductibles, coinsurances, and out-of-pocket maximums. Using the tool, preaccess associates can schedule and preregister patients and provide estimates during the same phone conversations. Staff also provide estimates for walk-in patients at the point of registration.

Presbyterian Healthcare Services: Assemble the best teams to support new technology. MAP Award winners know that human resources can make or break their investments in new technology. In 2017, Presbyterian Healthcare Services in Albuquerque, N.M., completed a two-year process to migrate its payer contracts from an outside vendor management system into its EHR.

Carefully evaluating employees and choosing the right team to support the new technology and processes was key, says Brad Cook, vice president of revenue cycle management. Leaders from network contracting, cost accounting, patient financial services, and IT were selected to work on the team based on their knowledge of payment and ability to work well with others under stressful conditions. After this team completed the initial build, a separate team of revenue recovery specialists—serving distinct roles based on their job titles—was formed to pursue claims that were not paid according to their contracted rates. “Level 1 specialists do the deep-dive analytics to mine and categorize payment variances, and then level 2 specialists conduct a root-cause analysis, validate payment variances, and initiate the appeals process,” Cook says.

In 2017, the revenue recovery team collected $5.7 million in additional net revenue from underpaid claims. For 2018, the team has set a $9.0 million target, which will result in an additional $3.3 million over 2017’s run rate.

ENT & Allergy Associates, LLP: Create a patient-friendly app. Several top-performing organizations are experimenting with apps. ENT & Allergy Associates, LLP, in Tarrytown, N.Y., allows patients to book appointments and pay copayments and any outstanding balances through an app that is downloadable on their smartphones.

St. Clair Medical Services: Use a charge-capture tool to reap the benefits of automation. At St. Clair Medical Services in Pittsburgh, revenue cycle leaders implemented an electronic charge-capture system that electronically transmits charges from the hospital’s EHR into the physician practice’s billing system. This interface has cut charge lag time from 5.4 to 3.8 days and eliminated manual entry, reducing the billing department’s hours by 40 percent.

St. Luke’s Hospital: Use AI to review unadjudicated claims. Several MAP Awards winners are testing AI tools to automate labor-intensive tasks and improve their revenue cycle performance. St. Luke’s Hospital in Chesterfield, Mo., uses an “AI bot” that automatically logs into payer portals to determine the status of claims billed within the previous 10 days. Within hours, the bot can report whether a claim was paid, pended, or rejected. The bot reduces manual work by staff, promoting higher productivity and a faster review cycle.

Collaborating with Non-Revenue-Cycle Staff

Providers with high-performing revenue cycles are engaging physicians and other non-revenue-cycle staff to eliminate bottlenecks and create more efficient workflows. Here are some practical ideas for cross-functional collaboration from four MAP Award winners.

Houston Physicians’ Hospital: Engage operating room (OR) staff to speed charge-capture. Leaders at Houston Physicians’ Hospital in Webster, Texas, added an OR coordinator who reviews nursing documentation, implant tickets, and other invoices and reconciles charges within 24 hours of surgery. If an account is held up for more than 24 hours, the OR coordinator records it in a communication log shared with the billing team.To support this initiative, the hospital also implemented a policy requiring device vendors to submit their implant invoices on the day of surgery. Getting vendors to comply has been a challenge, but by the end of this year, leaders at Houston Physicians’ Hospital will have the written policy entered into their vendor check-in system, so vendors will have to acknowledge that they accept the terms of the policy. Together, these strategies will help the revenue cycle team reach their goal of submitting the final bill less than 72 hours after discharge in most cases. To implement such an approach, revenue cycle leaders should involve OR leaders in the design of the process. “You need to have buy-in from all of the appropriate parties,” says Heather Womack, CFO. “Otherwise, it’s really hard to push a one-way initiative that spans multiple areas.”

Dignity Health Mercy General Hospital and Dignity Health St. Elizabeth Community Hospital: Work with clinicians to reduce days-not-final-billed (DNFB) accounts. At Dignity Health Mercy General Hospital in Sacramento, Calif., and Dignity Health St. Elizabeth Community Hospital in Red Bluff, Calif., clinical and finance leaders review reports to help track their progress toward their goals for both DNFB and final-bill-not-submitted (FBNS) accounts. By determining the root cause of problems and implementing corrective actions to address operational gaps and bottlenecks, clinical and financial leaders were able to reduce DNFB by $70 million for the health system in the first half of FY17.

Chesterfield Internal Medicine & Rheumatology, LLC: Have physicians and support staff “huddle” to improve patient flow. In 2017, physicians at Chesterfield Internal Medicine & Rheumatology, LLC, in Chesterfield, Mo., initiated daily huddles to streamline workflows and reduce patient waiting times. Physicians use a report developed by their IT team that identifies all patients on the day’s schedule along with basic clinical information on each patient. Using this report, medical assistants and registered nurses can take charge of pre-visit planning, thereby allowing the care team to move more efficiently through the day.

Enhancing Operational Efficiency

From improving point-of-service (POS) collections at the front end to keeping senior leaders informed of denials on the back end, winning organizations are employing creative methods to meet their performance goals. These tips from seven MAP Award winners offer insights on how organizations can streamline their operations.

St. Elizabeth Physicians: Create a better front-end process to check referrals and combat “no authorization” denials. Leaders at St. Elizabeth Physicians in Crestview Hills, Ky., centralized their authorizations and referrals under a central billing office (CBO) in 2014. The CBO partnered with the IT team to develop a process in their practice management system that automatically places referrals that require authorization into a special work queue for associates. With this labor-saving process in place, the practice has been able to redistribute 13 associates to other areas within the CBO.

Henry County Health Center, Jamestown Regional Medical Center, St. Clair Hospital, and Saint Francis Health System: Pilot one or more strategies to improve POS collections. Improving POS collections is a top priority for high-performing organizations—from critical access hospitals to community hospitals to integrated delivery systems.

Henry County Health Center, a critical access hospital in Mount Pleasant, Iowa, uses an insurance verification tool in the ED that alerts staff to patients’ copayment amounts so the staff members can request payment after patients have had their medical screening and toward the end of their registration—an approach that helps ensure the organization stays within Emergency Medical Treatment & Labor Act (EMTALA) guidelines. To inform the community of the change, the organization embarked on a three-month marketing campaign that involved radio and newspaper spots, social media posts, and newsletter announcements. Even more important than marketing was getting buy-in from physicians. “Some of the physicians were even telling patients that co-pays would be due, so when we started, it wasn’t such a surprise for patients,” says Charlie Hammel, director of revenue cycle. During the first week, staff collected more than $2,000 in copayments ranging from $3 to $50 or more, and they continue to improve their POS collections. Hammel believes that using a “soft collect” approach and keeping communication with patients simple and straightforward has been essential to their success.

At Jamestown Regional Medical Center, a critical access hospital based in Jamestown, N.D., the patient access team requests a “standard deposit” from patients based on a conservative estimate of the patient’s out-of-pocket responsibility. The team reaches out to patients prior to their service to inform them of the deposit amounts.

St. Clair Hospital in Pittsburgh was able to achieve POS cash collection for FY17 amounting to more than $3.1 million—12 percent greater than FY16. To help achieve this goal, patient access leaders at the community hospital worked with clinical managers in medical imaging and at the surgery center to map out the POS cash collection process in their departments. Clinical staff received training and software to minimize any additional workload.

At Saint Francis Health System, an integrated health system in Tulsa, Okla., leaders realized year-over-year increases in POS cash collection as a percentage of total patient cash collections from 19.7 percent in 2016 to 29.4 percent in 2017. An electronic benefit and eligibility system helps staff inform patients of their out-of-pocket financial responsibility and promotes prompt payment at the time of service.

Virginia Eye Institute: Focus on quick turnarounds for no-shows and cancellations. High-performing organizations have a proactive strategy for handling no-shows and cancellations. Virginia Eye Institute in Richmond, Va., requires a patient to pay a $50 fee if the patient cancels an appointment with less than 24 hours’ notice or simply does not show up for the appointment. “Our no-show rate was pretty high—up to 9 to 10 percent,” says Lovell Davis, director of revenue cycle management. “By putting this policy in place, we were able to get our no-show rate down to 5 to 6 percent.” Staff will proactively fill any openings with patients on a waitlist and immediately reach out to no-show patients to reschedule them.

Clifton Springs Hospital & Clinic: Keep senior leaders in the loop on denials. Implementing accurate reporting processes can help organizations uncover the cause of denials. In 2017, the team at Clifton Springs Hospital & Clinic in Clifton Springs, N.Y., established a denial reporting process in which all senior leaders receive a monthly scorecard that tracks hospital initial and final denials, physician initial and final denials, and other key performance indicators. The community hospital, part of Rochester Regional Health, also shares weekly initial denials reports with operational leaders to help them identify the root cause of errors and proactively prevent final denials.

Turning Ideas into Reality

As these examples from winning organizations illustrate, revenue cycle leaders who focus on building a patient-focused culture and selecting the appropriate technologies to serve their needs can expect to yield strong revenue cycle performance.

Organizations that want to emulate these best practices should zero in on a few key areas to improve efficiency and look for opportunities to collaborate with clinicians, IT leaders, and other non-revenue-cycle staff to pilot innovative solutions.

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Laura Ramos Hegwer 
is a freelance writer and editor based in Lake Bluff, Ill., and a member of HFMA’s First Illinois Chapter.