8 finance execs reply: What revenue cycle change worked?


In June, the Healthcare Financial Management Association named the winners of its annual 2020 MAP Award for High Performance in Revenue Cycle. To better understand the steps these hospitals took to raise their revenue cycle processes above industry standards, Becker's Hospital Review asked finance leaders at eight of the winning organizations: What's one example of a recent revenue cycle initiative that has led to direct improvements?

Here are their answers:

Sheryl DeCilio, vice president of patient financial services and revenue cycle at Hyannis, Mass.-based Cape Cod Healthcare. Cape Cod Healthcare started an initiative two years ago to improve patient satisfaction regarding patients' financial responsibility and co-pay collections. We reviewed our tools, communication methods and workflows to provide our patients with an easier way to make payments electronically and provide more accurate estimates for out-of-pocket expenses. We invested in technology that allows us to produce reliably correct patient estimates prior to or at the point of service. Simultaneously, we implemented an online patient payment portal allowing patients a seamless way to make payments electronically. We have seen a substantial increase in collections and positive response from patients. In 2019 compared to 2018, point-of-service and pre-service collections increased by 23 percent and continue to increase in 2020, up 39 percent year-to-date in February 2020 versus the same period last year.

Tamara Imm, vice president of revenue cycle at Unity Hospital in Rochester, N.Y. In response to COVID-19, we've been focused on facilitating limited-touch workflows, which includes fully leveraging EMR tools to allow patients to perform most of the registration, including copay collection, via our patient portal or through a preregistration team that contacts the patient prior to their scheduled visit. This system is in place for surgical procedures and is being piloted at ambulatory sites, and will continue to roll out to remaining ambulatory sites. We've also developed an in-house app to help facilitate notification and throughput workflows, mainly for unscheduled lab draws, to allow our organization to handle patient throughput in a socially distant manner. 

Steve Scharmann, system vice president of revenue cycle at CommonSpirit Health in Chicago, parent company of Dignity Health Mercy General Hospital in Sacramento, Calif. Dignity Health Mercy General Hospital recently performed work around Medicare's definition of inpatient-only procedures. Historically, many of these procedures were performed on an outpatient basis and were subsequently denied for payment. Hospital financial leaders, surgical leaders, care coordination, revenue integrity and physician provider relations launched a collaborative effort to proactively identify Medicare inpatient-only cases and plan accordingly. Surgery scheduling processes were revised to better capture relevant information about the procedure. This information is then analyzed and supported by a tool that immediately reports when a procedure is inpatient-only. Physician provider relations was engaged to educate physician practices on Medicare inpatient-only requirements and supportive tools to identify and track the delivery of care in appropriate settings. An immediate 50 percent reduction in Medicare denials for inpatient-only procedures was achieved upon implementation. Denial rates continue to improve as all involved parties developed a greater understanding of Medicare requirements and how they impact services offered.

Steven Downs, CFO of Princeton Baptist Medical Center in Birmingham, Ala. With the aim of reducing "lack of prior authorization" denials, meetings were held to pinpoint specific denial patterns and implement preventive solutions. Patient access, case management, billing, surgery and related departments, as well as facility CFOs implemented several workflow modifications to reduce precertification-related denials. An operating room scheduling form was developed to document procedures, CPT codes, admission type and pre-authorization processes to ensure appropriate communication with physician offices instead of call-in requests. During surgery, a "time-out" procedure was implemented when surgeons changed or added to the scheduled procedure being performed. Patient access would be contacted during the "time-out" so the service could be added to the authorization. The catheterization lab instituted daily huddles whereby cases from the previous day were reviewed to ensure those cases had the appropriate authorizations. 

John Maschger, vice president of revenue cycle at Liberty (Mo.) Hospital. The foundational effort of our revenue cycle consumerism strategy involved further investment in the hospital staff. Previous employee engagement scores were below the hospital and national averages. First-year turnover was at 28 percent in patient registration and higher in other departments such as scheduling (80 percent). We adopted a new education platform for required training and additional certifications for employees. Press Ganey results from the last employee engagement survey are now above hospital and industry scores after just one year's effort. Essentially, a better trained staff will better serve our patients' needs and improve their overall experience with our revenue cycle staff.

Brad Cook, chief revenue officer at Presbyterian Healthcare Services in Albuquerque, N.M. We recently deployed the capability for patients to retrieve their medical records through our online or mobile portal. Not only is this more convenient for our patients, but it also allows them to quickly obtain their medical records without having to physically enter a hospital facility. This has become particularly important during COVID-19. Another example is our implementation of new contactless registration features. With this approach, patients can now upload their own photo and insurance card into our EHR. In addition, contactless registration allows patients to e-check-in and proceed directly to the patient care room.

Ryan Thompson, senior vice president of revenue cycle at Christus Health, the parent company of Christus Shreveport (La.)-Bossier Health System. During fiscal year 2018, we identified a department that had issues with prior authorization. We know that often patient decisions have to be made immediately and then gain authorization afterward. We gathered representatives from patient access, revenue integrity and the specific department to better understand current processes for verification and authorization. The analysis identified a lack of communication between teams, and in collaboration with the department team, a new, streamlined process was implemented. In the new process, before a patient was administered treatment or medicine, the clinical staff verified what was authorized for the patient, and denials for lack of authorization decreased by 62 percent with the newly refined process, staff accountability and support of leadership.

Billie Jean Mounts, chief revenue officer for Bon Secours Mercy Health in Cincinnati. Bon Secours Mercy Health has focused on improving automation in revenue cycle operations. We've implemented robotic process automation to help maximize resources for insurance authorization submission and status processes. RPA is triggered at the point of scheduling to automatically check payer sites for authorization requirements and status. The information is then auto-populated back into the patient accounting system to drive workflow. If the authorization is present and verified, the account is removed from the patient access work queues without any human intervention. Revenue cycle realized a 30 percent increase in accounts automatically resolved via RPA status response within the first month of implementation. Automation of authorization submission has been implemented as well, facilitating a single-screen submission of clinical criteria by our authorization team and automating the submission to various payer portals. The automated submission workflow reduces the inventory of accounts to process manually by 20 percent.

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