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 reengineered 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 payor 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 (E-E)
Key Outcome and benefits:
- Reduced denials
- Improved re-contracting with payors to reduce rejections
- Prompt query resolution process (of payors)
- 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
