When it comes to revenue integrity, the smallest details matter

There is a moment in “The Defiant Ones,” an HBO documentary that chronicles the legendary partnership between music producers Jimmy Iovine and Dr. Dre, when Iovine’s early success or failure hinges on one word: “Stick.”

At one point, Iovine was working with Bruce Springsteen on the follow-up to Born to Run, Springsteen’s landmark third album. He spent six weeks working round the clock with the drummer to perfect the sound — from thumping drum sticks against rolls of carpeting to recording drum sounds in the elevator, the hallway and even the bathroom. But instead of the booming sound Springsteen sought, all Springsteen could hear was the clunk of the drumstick. “Stick!” is all Springsteen would say when the drum sounds weren’t what he wanted.

The relentless drive toward perfecting a single sound is an example of the value of each small detail to the success of an entire project. That’s especially true in healthcare, where a single missing detail can cripple the chances for appropriate reimbursement.

Critical notes for revenue integrity
Twenty-two percent of hospital revenue cycle executives say their top focus for the coming year is revenue integrity, a state of optimal efficiency, effectiveness and reimbursement, according to a recent HFMA survey1. Yet just 44 percent say their organizations have a revenue integrity program. And without one, coding, charge capture, pricing for services and compliance are all at risk.

The good news is there are four clear areas where hospitals and health systems can more effectively use technology to improve revenue integrity.

1. Automate scheduling processes. It takes several minutes to manually schedule a patient appointment, and often, the manual work that goes into this task is in vain: community hospitals average 62 no-shows per day, while no-show rates at teaching hospitals average 25 percent.2 Even when patients do call to reschedule, there’s no guarantee they’ll make the appointment. Women are more likely than men to reschedule — perhaps no surprise, since women make the majority of healthcare appointments for their families.

But what if hospitals and health systems were to put scheduling in the hands of patients with online, self-service technologies? Not only would these organizations be able to redirect schedulers’ time toward more value-added activities, but they also could use real-time data to verify the demographic and insurance information they have on file is accurate — and prompt patients to make corrections when it isn’t. This improves the chances of a clean claim and helps eliminate the need for rework later. One health system improved its ability to schedule by 40 percent through the use of automated technology, eliminating the need to hire more staff.

2. Verify patient eligibility at the point of contact. By 2019, the amount providers collect directly from patients could increase by 50 percent — and the higher the out-of-pocket responsibility, the harder it becomes to collect on patient balances.3 Automating eligibility checks at the point of contact can help pinpoint patients who qualify for government assistance or charity care early in the encounter. Staff can then help patients enroll in such programs before care rather than after services are delivered, protecting revenue while easing financial anxiety for patients.

3. Provide financial estimates before treatment takes place. In three minutes or less, self-service check-in platforms with built-in insurance verification capabilities not only can signal the front desk that a patient has arrived, but also can tell patients how much of their deductible already has been met and the amount they will owe for their visit. When combined with technology that enables patients to make payments directly from a kiosk, point-of-service collections increase — and so does patient throughput.

Automated technologies also can score the patient’s likelihood of payment based on the patient’s credit history, demographic information and the size of the balance the patient is likely to owe. Based on the score, staff can begin financial counseling early and proactively help patients navigate options for payment. This reduces the cost to collect while providing a valuable service for patients.

4. Analyze the EHR for areas of revenue leakage. Years after its EHR implementation, one large academic system discovered 70 areas where it was losing revenue, each related to EHR process workflows that could be fixed with staff training. Look for areas where data isn’t moving properly or where charges are lost before they are billed.

Record a breakthrough performance
Springsteen’s follow-up to Born to Run — Darkness on the Edge of Town — achieved critical acclaim for the power of the bass drumming, a feat that wouldn’t have been possible without painstaking attention to detail and the drive for high-quality performance. Similarly, with the right focus, processes and technology, hospital revenue cycle teams can achieve next-level revenue integrity. Successful providers will end each patient encounter on the right note — improving satisfaction while protecting the financial

1 http://www.hfma.org/Content.aspx?id=54666
2 http://www.healthcaredive.com/news/hospitals-are-finding-new-apps-to-tackle-an-old-problem-patient-no-shows/417880/
3 http://www.modernhealthcare.com/article/20150516/MAGAZINE/305169974

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