Is there a template for a new physician practice management system implementation plan geared towards denial management and collection modules? If not, any guidance for test scenarios and cases for denial management are appreciated.
Answer 1: I would expect that the chosen vendor would have a defined implementation project plan with clear steps, tasks, and timelines laid out, and their project manager, along with your operational and IT support resources, would fine tune that to meet your needs. I would not expect the individual practice to define that from scratch.
With respect to user acceptance testing (UAT), the following capabilities would also be defined between the vendor and operational staff:
- What system functionality should be confirmed to ensure it works as expected (e.g., pulling up accounts, validating they are where they should be based on rules, and validating that they attribute to the account)?
- If an action is taken (i.e., complete an account/task), did it work as expected?
- Does printing function work (e.g., letters, attachments)?
- Is an outline of staff daily operations outlined (i.e., how they will perform their jobs using the new tool)? Super Users are usually included in both defining the scenarios and completing UAT.
This question was answered by: Christine Fontaine, CHFP, CPAM, senior director, revenue cycle optimization, Connance, and is a member of HFMA’s Maryland Chapter.
Answer 2: I would agree with Christine. I just went through a hospital revenue system change and did a professional billing implementation many years ago. Vendors have performed these activities many times before, so you can lean on their experiences. And they need you to succeed so you will pay the final bill and recommend future clients. They will provide an implementation plan complete with timeline and roles, which you can fill with your own folks or consulting help.
As for testing, you know the scenarios that are most common in your hospital, so gear your testing to make sure those are included. For example, here in New York we have certain odd insurance plans that we needed to make sure would be handled, as well as a state hospital tax. We also focused a lot on how the claim scrubbing would be updated and integrate with our workflow to prevent denials, and how granular our payment and denial data would be. Visiting another hospital that is already using the system will give you a sense of how different your goals/needs are from the norm.
This question was answered by: Ruth Landé, senior vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, and a member of HFMA’s Metropolitan New York Chapter.
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