How one health system cut 5 days in accounts receivable

Baptist Health System, based in Birmingham, Ala., converted to the Epic enterprise EHR in 2013. The system complemented its new EHR with its established data analytics provider MedeAnalytics.

Cindy Elder, manager of revenue systems at Baptist Health, describes her system's experience working with the combination of Epic and MedeAnalytics for revenue cycle management.

Question: Why did Baptist Health System decide to convert to Epic?

Cindy Elder: The decision to convert to Epic was necessitated initially by the clinical side, in response to obtaining meaningful use dollars from the government's mandate regarding the installation of an EMR. Purchasing the full-blown enterprise license of Epic just made sense, so we could consolidate the multiple disparate systems into one that is streamlined from front-end to backend with clinical and financial aptitude.

Q: What features of the Epic system have allowed Baptist to improve revenue cycle processes?

CE: Some features that offer significant improvement over our previous system:

1. We have the ability to view the contract terms of the expected reimbursement calculations  on each patient account, except outpatient Medicare ambulatory payment classifications. This is especially helpful for our follow-up area, as they can see specific line-item detail of how we expect the claim to adjudicate and then review the EOB to see how it actually paid so they can follow up appropriately on variances.  

Regarding outpatient Medicare APC, we do not calculate expected reimbursement directly within Epic, but instead we pass through the 3M Outpatient Core Grouping software to calculate the expected reimbursement. Epic has recently added the functionality to provide this from within the system, but we have not yet implemented it.

2. Epic has built-in claim scrubber edits that allow for corrections earlier in the revenue stream. Even the front-end patient access area has work queues with edits requiring or suggesting correction. We still utilize a third-party billing system, but we are much more efficient by making the corrections on the host system.  

3. Epic also has a built-in, interactive dashboard with performance trending, which allows drill down to the account level. One item in particular is an area of "Watch List" items. This includes things such as "DNB not on work queue," which is a list of accounts having a DNB error but that are not on anyone's work queue. This helps us to ensure nothing falls through a gap in our setup or processes.

Q: Why was MedeAnalytics selected as the data analytics provider?

CE: Our VP had previous experience as a MedeAnalytics consumer and had outstanding results. She had been at a health system in Orlando that lacked any full view into the revenue cycle. MedeAnalytics worked with her to build real insight into the revenue stream, which was integral to turning around that business office. With such a great record of accomplishment with MedeAnalytics, it was an easy decision to bring them in to the Baptist Health System as well.

Q: How does the Epic system work with MedeAnalytics?

CE: We have a nightly procedure set up to extract snapshot account data as of midnight, as well as all transactional data from the previous day. This data is loaded into the MedeAnalytics' database where historical data also resides. Detail and summary reports exist to meet the needs of users from patient access to the business office to finance.

In addition to pre-built reports, dynamic queries and reports can be built and detail data pulled for current snapshots or trended snapshots, allowing users to see patterns in the data and draw conclusions. It is a great complement to Epic, allowing the ability to trend across various time periods. In addition, complicated metrics and derived fields allow further analysis that is unavailable in Epic.

Q: What changes have you seen since implementing this system?

CE: Implementing MedeAnalytics in 2005 allowed us to streamline our reporting, ensure reliability and improve turnaround on reports and analytics. In addition, we utilize MedeAnalytics for valuing our reserves, the aggregate of which is then applied directly to our general ledger accounting system.

Having MedeAnalytics already in place when implementing Epic in April 2013 allowed us to have consistent reporting encompassing both our legacy and Epic data. With Epic, we have realized significant improvement in several of our most indicative key performance indicators. For instance, comparing March 2013 to March 2015, our DNFB (discharged not final billed) days have decreased from 4.1 to 2.5, while our overall A/R days have decreased from 42 to 37. In addition, our cost to collect has been reduced from 3 percent to 2.5 percent.  

Q: What advice do you have for other health system leaders looking to improve revenue cycle management?

CE: It all starts with the foundational patient accounting system. Since switching patient accounting systems is such a massive move, you will likely need to focus on making what you already have in place work for you. Spend the time and money to train your resources to be adept in maintaining the system, as well as training your user community to be proficient on processes and procedures. Optimize the system fully and perform routine audits on any automation implemented. You also need to ensure that you have adequate views into the data for proper monitoring and trending in order to provide actionable insight.

More articles on revenue cycle management:
Your only realistic path for reducing revenue gaps
RCM tip of the day: Optimize scheduling
RCM tip of the day: Use an EOB-to-ERA conversion tool

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