In September of 2019, HFMA released a study of 108 hospital and health system chief financial officers and revenue cycle executives, with 62% of the group suggesting EHR adoption challenges have been equal to, or outweighed, benefits specific to their organization’s revenue cycle performance. This was an increase from 56% in the prior year (2018).
Leading up to this study, a mid-2018 Dimensional Insight and HIMSS Analytics report showed 76.1% of respondents noted claims denials as a top challenge to their revenue cycle. With revenue cycle as a focus of so many in the healthcare industry, it is important to focus on solidifying or expanding revenue cycle program.
Supporting the revenue cycle efforts of clients across edit reconciliation, denials management, clinical documentation improvement, and coding; the TrustHCS team has a unique perspective on where improvements can be made. Working within Cerner, Epic and other major EHRs unveils some of the sources of client pains related to the revenue cycle and where quick wins can be gained with proper system and team shifts in focus and effort. Here are some of the areas to investigate and make the most impact.
Deep Dive Into Your Workqueues
EHR implementation is complex. In conjunction with implementation, communicating organization workflow is also difficult. The complexity of implementation and workflow redesign often creates queue backlogs and elevated DNFB (discharged not final billed) and AR.
Analysis of existing work queues post-implementation should include tracking each encounter type and payor scenarios through the workflow and queues to understand where they are landing. It is not uncommon for recent implementations to have encounters waiting to be worked for long periods of time simply because they’ve dropped into an inappropriate queue.
If a backlog exists, it’s also important to analyze the work effort needed to get the backlog addressed. This includes determining priority of the queues and understanding the bandwidth of current staff to tackle the backlog. Often, outsourced labor is needed to help address these areas.
Set Goals and Plans for Denials
Industry information on denials is readily available and can be used to understand how the denials coming back to your organization stack up to your peers. Once you understand the overall denial percentage that’s typical for your patient mix, you can determine if adjustments are needed to drop into a more normal range.
Denial management can also be bucketed into clinical and technical denials. The bucketing is used to parse out responsibility of responding to these denials in a timely and organized manner. A deeper assessment of denial reasons and the quantity of denials on an annual basis will help establish staffing needs.
Plan for Coding Quality and Appropriate Reimbursement
Most healthcare organizations outsource at least a portion of their coding efforts. In doing so, these coding providers (i.e. TrustHCS) extend quality assurance (QA) monitoring services that audit the coding to help ensure accuracy, and adherence, to coding standards. These same QA efforts should be extended to your organization’s coding staff on a programmatic level. A simple way to create a plan for coding QA needs is to use the following formula:
# of annual encounters x % of work you wish to QA = Annual Encounters for QA Review
Annual Encounters for QA Review / Auditor Productivity in each chart type = Annual Hours of QA Review
Add to these calculations additional time for compilation of QA findings, and necessary education back to your coder on said findings, to get an estimated QA investment.
Jump Start Your Program Planning
Whether you are just beginning to investigate revenue cycle program improvements, or deep into your analysis, the TrustHCS team can provide you a boost to your planning. Applying various industry best practices, studies, and experience from thousands of client projects; TrustHCS can generate a program analysis that will give greater insight and direction to your planning efforts. You can learn more about this complementary analysis and request your report at www.trusthcs.com/programanalysis.