Boca Raton (Fla.) Regional Hospital has been undergoing a tremendous amount of change during the last five years, much of it related to revenue cycle management improvement. "For the hospital, streamlining its operations and better aligning with third-party partners to best serve the system has been a top priority," says Rudy Braccili, executive director of revenue cycle services at the hospital.
The regional hospital was established in 1967 and provides cardiovascular care, oncology, women's health, orthopedics, emergency medicine and the neurosciences, with state-of-the-art diagnostic and imaging capabilities. It has received several awards, including 2014 Distinguished Hospital Award for Clinical Excellence from Healthgrades, an award it has received the past 10 years — only 24 of the nation's 4,500 hospitals have earned such a consecutive distinction — and it has been recognized as one of America's 50 Best Hospitals in 2011, 2012 and 2013, among other awards.*
But just five years ago, before a complete change in hospital leadership, the facility faced a variety of Medicare audits and penalties. Now, though, because of its change in priorities, the non-profit —with 400 beds, more than 2,100 employees and more than 800 primary and specialty physicians on staff — is seeing a complete financial turnaround.
Mr. Braccili says that Boca Raton Regional Hospital's internal processes and systems were bloated. Inefficiencies could be found throughout the health system. Much has changed largely because of new leadership, new business processes and new vendor relationships. One significant change is in how the hospital now manages its responses to Medicare audits. Recent changes Medicare made to its audit program allows for the processing of documents electronically, and now hospitals can easily, automatically and securely exchange health record documentation and medical attachments when responding to third-party auditors. Prior to 2011 the response process was entirely paper-based.
CMS launched the Medicare's Electronic Submission of Medical Documentation program to provide a mechanism for health systems to electronically submit documentation in response to additional requests and audits.
"For responding health systems, the process had been cumbersome," says Mr. Braccili. For many it still is. Many hospitals are still printing, sorting, packaging and mailing documents to support original claims to Medicare to adjudicate their bills, because they are not using an electronic attachment solution. Since one patient record can fill a box or more, hospitals are left paying for the lion's share of all materials, labor and shipping involved, which can amount to an enormous annual cost.
Boca Raton Regional Hospital began electronic data transfers to Medicare in August 2012, partnering with MEA|NEA. The hospital was one of first in the nation to do so as part of Medicare's pilot program. MEA|NEA focuses on helping health systems improve their revenue cycle management processes and streamline the secure exchange of health information, eliminating paper and manual processes when adjudicating payer claims and responding to Medicare auditors. Its solutions ensure that protected health information required for claims and coordination of care is electronically transferable and available in a secure electronic format.
"The Medicare audit process has drastically improved because of the hospital being able to submit documents electronically, and denials related to untimely submission of records have disappeared entirely," Mr. Braccili says. "For example, Medicare allows 45 days from the date of record request for hospitals to respond, but Medicare still sends documentation requests by paper. Typically, by the time the paper request gets to the proper department in the hospital more than 10 days may have elapsed. Managing the entire process requires a very strict time requirement and hospitals often fail to return records to Medicare on time, which means hospitals can no longer appeal. By automating the process and securely depositing electronic attachments to Medicare's official information portal, Boca Raton Regional Hospital has prevented the loss of at least $350,000."
From a revenue cycle management standpoint, electronic attachment submission has been a very good thing, ultimately helping it save millions. Since auditors typically "go where the action is," if they continue to recover money from certain hospitals they'll likely continue to audit them, Braccili said. As such, because of improved clinical processes and documentation, and electronic attachment submission, Boca Raton Regional Hospital has seen a dramatic decrease in negative outcomes of audits since it began doing so in 2012.
"For years we've been begging for electronic record solutions for Medicare," he says. "For more than 10 years, other payers and health systems have been very receptive creating new efficiencies in submitting records and other documentation electronically. We wanted that here for Medicare as well — our number one payer in terms of transaction volume."
Additionally, doing so creates accountability for all parties involved in the process.
"The hospital's transformation involves several factors including a change in focus, leadership and efficiencies created, in part, by new vendor relationships," Mr. Braccili agreed.
Lindy Benton is president of MEA|NEA.
*Boca Raton Regional Hospital has received its 2013 Women's Health Excellence Award for the fourth consecutive year and the 2012 Emergency Medicine Excellence Award for the third year in a row from Healthgrades. U.S. News & World Report's 2013-2014 Best Hospitals listed it as a top-ranked hospital in the South Florida metropolitan area, and the hospital's Christine E. Lynn Heart and Vascular Institute has been named twice as one of the Top Hospitals with Great Cardiovascular Programs by Becker's Hospital Review. In 2013, the publication also recognized the Eugene M. & Christine E. Lynn Cancer Institute as one of the 100 Hospitals and Health Systems with Great Oncology Programs.
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