Pennsylvania health system eyes cash acceleration, cost-savings from new RCM technology

When DuBois-based Pennsylvania Mountains Healthcare Alliance set out to choose a tech platform to manage the system's revenue cycle, the main goal was to find one end-to-end solution that would support PMHA's 13 community hospitals for years to come, Nicole Clawson, vice president of finance and revenue cycle, told Becker's.

"Before, we had multiple vendors with various platforms that managed various pockets within a revenue cycle. They were separate databases that weren't connected to each other," she said. 

Further, at the time, her team was doing a considerable amount of manual reporting. "We were having to piece information together to get the reports we wanted. We wanted to understand what was happening so we could identify issues and save time by automating revenue workflows," Ms. Clawson said. 

The health system landed on FinThrive's Revenue Management Platform, which brings all parts of the revenue cycle together in a central system.There are multiple levels of installation and training, so while all the hospitals in the system will eventually be onboarded, Ms. Clawson said she is focused on a slower, strategic rollout. 

On March 15, four hospitals began using the contract management part of the platform, and one hospital launched the claims management component on the back end. 

Becker's spoke with Ms. Clawson about her expectations for the new technology in PMHA's hospitals and the biggest ongoing opportunities it will provide for PMHA. She also offered one piece of advice for her colleagues in hospital finance and revenue cycle management.

Editor's note: Responses have been lightly edited for brevity and clarity.

Question: Why did you decide to centralize your revenue cycle management technology?

Nicole Clawson:  We wanted to create efficiencies within revenue management, especially around expense reduction. When we started looking, we were focused on finding a technology that could support us now and five to 10 years out. We are already having trouble finding talent, and we knew we had to find a way to become more efficient so we can utilize the people we have in the most optimal way.

Q: What opportunities does FinThrive's platform offer your hospitals? 

NC: We took on an ad hoc project with one of FinThrive's products, Insurance Discovery. We knew it had the potential to help us submit our self-pay claims that were sitting out there [not getting paid]. Maybe they were claims where patients had notified us of the correct insurance. We were told we could run these through the system. Was I skeptical? Yes, when we signed up. But it has proven to be very effective and is a part of the system we will likely look to continue to use.

Also, the opportunity for partnership is also important. When we were looking for a vendor, we didn't want to just find a "vendor." We wanted to pick a partner, a company that understood our model. FinThrive hit those buttons.  

Q: What are the toughest revenue cycle challenges you're dealing with right now?

NC: After COVID, we are focused on building back efficiency and standardization. Pre-COVID, we had been good at what we do, but now we have to refocus and build back those efficiencies and processes. 

Q: Do you have any data to suggest that an end-to-end system approach will create the efficiencies you talk about?

NC: Absolutely. Here's an example: Patients don't always provide the correct information when they walk in the door. This platform allows us to track data from a patient's point of entry to when the bill goes out. When there is an error, we don't get paid. This system is able to help with the insurance discovery piece and we get better returns from the payers. 

Another example is labor costs. This system is going to be key to automating tasks and helping our staff do their jobs better. 

Also, we're in budget season and my catchphrase for fiscal year 2024 is "revenue optimization." We've been in a cleanup mode from COVID and now we have to optimize our revenue. I'm not saying we should get more than we deserve, but we also should not get paid less. We believe our new system will help us get paid accurately for the services we provide. 

Q: What are the biggest opportunities for PMHA now that you have this new RCM technology?

NC: The biggest economic opportunity is cash acceleration. With clean claims going out the door, they can return as cash more quickly. 

We want to stay ahead of the changes as much as possible, and [embracing] a culture of innovation is going to help us do that. We can make sure we have clean data in the system so we have a reduction in denials. The key to that is having the information going out the door correctly. Additionally, we are making sure everyone has access to information on one central platform. And, again, the ability to automate is big for us.

Q: Phase one of FinThrive's platform is contract management; what are the other phases of installation?

NC: Phase two is the back-end billing workflow and a denials analyzer. Phase three is the front end focusing on patient eligibility and patient estimator. We are being very methodical and strategic about the rollout. We want to make sure that we customize the system for our needs. Doing this will make installations at the other hospitals go more smoothly and quicker.

Q: Are you seeing any challenges with implementation?

NC: Technology is only as good as the people who use it. So, we are focused on making sure our staff has the training, tools and workflows to be able to use the system. We want to have the best outcomes.

Also, it's important that both the clinical and revenue staffs can understand and access the system. We want clinicians focusing on the patients, but as we've evolved in healthcare, they do have to be accountable and knowledgeable so they get paid for the services they provide.

Our goal is making sure the platform is understood by very different departments within the hospital.

Q: Are there any tech trends in revenue cycle management that you are particularly excited about? 

NC: I realize it's an unknown, but I'm excited about how we are going to automate by using AI and bots. For example, perhaps we can automate checking on pre-service eligibility. On the back end, maybe we can use bots with collections. We could have a bot monitor collection statuses and reach out to the payer to collect. This isn't an effort to eliminate staff, but it will help us make the best use of the staff that we have in each hospital.

Q: What's your advice for a healthcare system that hasn't upgraded the RCM platform?

NC: Don't hesitate.  

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