04October
Improving Revenue cycle efficiency, controls and processes for a large Women and Children Hospital 0 Comments | By admin
Business problem:
Client needed assistance to improve the process of revenue cycle (end to end) to enable improved revenue realization.
The process of patient access, health informatics, coding and financial operations needed to be re-engineered for smoother flow of cases
Improved organization of the RCM team to improve follow ups and reduce denials
Identify system controls that will enable adequate information collection at patient access
Solution Approach:
Reorganized the RCM team to work as a single unit, with shared goals
Identified clinical, demographic, physiological and situational rules that were coded in the Cerner system (as checks)
Redesigned the processes for smoother and complete flow of information, physician query resolution and payer follow-ups
Developed a process to adequately maintain CDM
Conducted denials analytics and developed controls around various factors that contributed to it, like: eligibility verification, plan selection, patient information, clinical documentation, etc.)
Defined lead indicators and set up process effectiveness team to constantly monitor and improve RCM process
Key Outcome and benefits:
Reduced denials
Improved re-contracting with payers to reduce rejections
Prompt query resolution process (of payers)
Improved clinical documentation, leading to lesser rejections
Reduced bill hold time from 15 days to 5 days
Adequate checks and controls on the system to eliminate errors in information collection during registration
Setup of financial counselling to reduce “self-pay” outstanding
Reduced duplicate MRN/s
