Working in a healthcare environment with complex payer structures requires revenue cycle management that is agile and resilient. This can be facilitated through intuitive technology that not only simplifies and automates workflows for staff, but also provides easy access to KPIs that deliver insight into the efficiency and effectiveness of billing processes.
At Pender Community Hospital, we’ve been able to shift from traditional productivity metrics to a more holistic approach that enhances revenue cycle performance and streamlines productivity management. By adopting a structured, data-driven approach and developing strong partnerships with collaborative vendors, we have been able to reduce inefficiencies and achieve better financial outcomes.
Moving on from legacy systems
As a critical access hospital with several rural health clinics, we consistently evaluate processes to ensure we are meeting our goals as a trusted community healthcare partner. In previous years, it was challenging to achieve optimal revenue cycle performance due to limitations of our legacy systems. Our team was burdened with outdated billing rules and manual data capture processes that created issue resolution inefficiencies and AR backlogs. The lack of reporting tools and visibility into clean claims and denials hindered our ability to track, resolve, and strategize around revenue cycle optimization due to limited time and resources.
In 2023, we moved on from our legacy systems and chose MEDITECH due to its long-proven functionalities, specifically workflow efficiency. Implementing an intelligent EHR platform gave our organization the opportunity to transition from traditional billing management to a holistic data-driven approach. The ability to review accounts efficiently allowed us to make more informed decisions and adjust workflows to increase production of clean claim submissions to the clearinghouse. We were also able to align billing processes with industry best practices to improve financial health.
However, executing a large-scale transition of this nature comes with its own set of challenges. We went LIVE with MEDITECH knowing that our claims build wasn’t fully complete and being a critical access hospital with rural health clinics creates payer rule complications. Our staff spent countless hours with MEDITECH building different payer guidelines and rules in the claims dictionary. As time went on, our AR days started building up and we needed assistance to manage the situation.
Prioritizing collaboration for optimal results
Our team decided to meet with Tegria, a MEDITECH Alliance member, to review and understand the AR backlog in our system. Tegria helped us leverage MEDITECH by reviewing the claims build and capturing the nuances in our clearinghouse. This provided the insight needed to move billing routines back into the EHR and to review how we charge items, improving billing efficiencies and ensuring accuracy for maximum reimbursement.
Reviewing the AR backlog helped us determine that our clearinghouse was not set as needed to reach all payer sources or return denied claims. Instead of writing these claims off, we decided to investigate further. By pulling data from MEDITECH, compiling reports, and completing payer outreach for claims resolution on aging or denied claims, we were able to resolve claims issues and overturn or waive timely filing for numerous payers.
After seeing great progress on our backlog of claims by February 2024, our clearinghouse experienced a widespread cyberattack. We acted immediately and ended a longstanding contract with them and quickly moved to a new vendor. With Tegria’s help, we were able to achieve a smooth transition and claims were back up and getting out to payers in a timely fashion.
Driving data-driven improvements
With easier access to real-time data, our revenue cycle tools now promote proactive account management. But we don’t want a change in technology to result only in short-term success. In order to place our hospital in the best position to achieve long-term financial health, we have implemented strategic methodologies that drive sustainable data-driven improvements.
As part of our revenue cycle management strategy, we have integrated the DMAIC process, a data-driven methodology aimed at improving processes and solving problems. The DMAIC framework consists of five phases: Define, where specific issues like delayed claims or high denial rates are identified; Measure, which involves collecting data on current performance such as AR days and claim denial percentages; Analyze, where the root causes of issues, like coding errors or missing documentation, are pinpointed; Improve, which focuses on implementing solutions to address these root causes, such as claim dictionary changes or account checks; and Control, where processes are put in place to ensure sustained improvements, like regular KPI monitoring and automated reporting dashboards.
Following this structured approach, our team has established clear reference points for improving revenue cycle processes, leading to better cash flow, reduced write-offs, and enhanced communication with billers and vendors.
|
Key Revenue Cycle Metrics |
Where We Started |
3 Month Check In |
Where We Are Now |
|
AR greater than 90 days |
44% |
31% |
29% |
|
Days in AR |
55 |
35 |
30 |
|
Denials as a % of AR |
21% |
12% |
6% |
Simple solutions to complex issues
By defining specific problems, measuring key metrics, analyzing root causes, implementing solutions, and developing controls, we have been able to create a clear picture of financial health and showcase our organization’s revenue cycle performance. This approach reflects the principle of Occam's Razor — which seeks the simplest solutions to complex problems. By focusing on eliminating unnecessary complexity in workflows and claim processes, and using real-time data for decision-making, we’ve increased operational efficiency and achieved positive financial outcomes.
At Pender Community Hospital, we continue to educate our staff on areas of concern through KPI reporting and leverage our EHR to ensure data is digestible and actionable. By rethinking what productivity means to our organization and taking advantage of the right technology, we have made a positive impact on our bottom-line and a better experience for our tight-knit patient community.
Learn how MEDITECH's revenue cycle solution helps you build a solid foundation for long-term financial health.
