All Entries in the "Benefits" Category

How to Overcome Financial Challenges in the Healthcare Revenue Cycle

by John Mangan , Senior Product Strategy Manager

New approaches to revenue cycle management are helping healthcare administrators sleep better

In today’s dynamic world of patient admissions, circumstances and policies change frequently. When saying and doing the right things at the right time can mean the difference between 100% reimbursement for services and a bad debt write-off, how can you ensure that the right information is captured?

The Stuff of Sleepless Nights

As consumer demand for medical services grows, so do the financial challenges. And the numbers are staggering. According to the American Hospital Association, 60 percent of hospitals in the U.S. lose money providing patient care.  While that percentage might seem high, it’s even more shocking when paired with the statistic that healthcare providers lose $60 billion a year due to registration errors alone. The quality of the data that enters the system upfront is often the single most important factor in determining whether the resulting claim will be paid or denied.

Registration errors can result in reduced cash flow, increased account receivable days, lost revenue, and wasteful rework. It is not surprising that healthcare providers are focusing on registration accuracy.

 Today’s complex patient registration processes require the handling and management of huge amounts of patient and insurance information, including insurance eligibility verification, demographics and credit risk,. What is crucial is how to deal with the data, turn it into information that drives action, integrate it with other patient information and then guide the registrar with the next step to take in order to make the registration process effective.

The Gateway to Improved Healthcare Revenue Cycle Management (and Better Cash Flow): Better Patient Admission Processes

According to a recent TripleTree Industry Analysis (Healthcare Revenue Cycle Management), there are a number of factors such as inefficient administrative processes, uninsured patients and regulatory pressures that are contributing to the breakdown of efficient revenue cycle management. However, the “gateway” where all these factors converge is during the initial patient registration.

Move Knowledge to Where It’s Needed

In hospitals, like other institutions, the knowledge required to productively interact with customers at the front end frequently is buried in the back office. The problem is not the lack of knowledge or even inefficient knowledge management, but rather one of the inadequate knowledge distribution. The knowledge exists, but it’s not always at the right place or in the right form where and when it is needed. So how do you take “on the shelf” knowledge that resides in the organization and convert it into “actionable” knowledge that can be used by employees who interact with patients?

 Intelligent Guidance

What’s needed is an intelligent guided system that:

•  monitors all patient information
• interprets patient information in relation to the healthcare provider’s processes and rules
• eliminates data quality and consistency problems, and
• provides automated or focused guidance through every step of the revenue cycle

 Such a system will ensure that only appropriate questions are asked of each individual patient and that all hospital rules are consistently followed by all front-end personnel to ensure that the information entered in the system is correct.

 Benefits

The immediate benefits of an intelligent guided system a:

 Revenue Improvement

• Faster claims payments
• Less denied claims
• Less time in accounts receivable

 Cost Reduction

• Fewer errors leading to lower cost of rework
• Reduction in time to train insurance information changes
• Reduction in the risk of Medicare non-compliance

 Registrar Morale

• Improved competence of registration personnel
• Improved job satisfaction
• Increased productivity

 Patient satisfaction

• Faster registration
• Fewer billing errors

A comprehensive, intelligently-guided patient registration system will provide a tremendously positive impact on the hospital’s revenue flow. And focusing on improving the quality of data gathered and recorded at the front end is potentially the best way to make the leap to better financial performance.
John Mangan is the Director of Strategic Product Direction for Cincom Systems. He has solved business problems through automation for manufacturing, financial services, and healthcare organizations for 20 years. Also, he is an active member of NAHAM and HFMA. jmangan@cincom.com

Innovative Approaches Can Help Rectify Problems at the Front end of the Healthcare Revenue Cycle

by Chris Woodhead, Director Cincom Intelligent Business Applications.

Let’s analyze how most issues in consistency and validity occur at the very beginning of the revenue cycle, right at the point of registration. 

The registration process is often harried as patients can access hospital services through multiple entry points – like inpatient, outpatient and the emergency room – which often doesn’t allow for a consistent registration process. 

Registration is decentralized and at times, clinical personnel, instead of a registrar, will complete the process. Because of this, it is extremely difficult to ensure that all hospital personnel conducting registrations follow the best practices 

Compounding the problem, hospital information systems are not designed to help patient-facing employees through the data capture process at registration. 

These factors result in duplicate patient records, incorrect patient information being captured and inaccurate insurance details which hospitals are then faced with re-working in the back office. If they cannot correct the false information they must foot the bill for delayed payments and loss of revenue due to unpaid services. 

Ideally, every person who registers a patient should be aware of what to do to avoid these problems. However, the reality is that achieving a level of registration expertise and ensuring that best practices are always followed by everyone in an organization is almost impossible. 

Hospital staff report to different departments where the main job is not always patient registration. These employees don’t fully understand the system, or simply want to get patients registered in the shortest amount of time with as little hassle as possible. 

So what can hospital administrators do to reduce this problem?
Auditing used to be the usual answer, but that can become a game of cat and mouse as hospitals race to catch errors and correct them before they get too far. But, it still allows incorrect information to be collected. 

Increasingly, hospital administrators are turning their attention to preemptive error prevention. Technological innovations are helping healthcare providers do so by allowing them to use systems that integrate with their Hospital Information Systems to provide guidance through the registration process. 

Such systems guide the hospital employee through context specific questions to help aid in the gathering of complete and accurate information, while checking the validity of data being entered. Questions are dynamically driven by the information already known about the patient, the new information entered and the logic determined by hospital administrators. Using this approach administrators ensure that errors are virtually eliminated before they are entered into the system.
Even the most inexperienced hospital staff can navigate flawlessly through even the most complex registration scenario, safe in the knowledge that the registration will be completely error-free. The registration process becomes stress-free for those involved, the amount of re-work necessary decreases and hospitals see their revenues increased while their AR days are reduced. 

With such benefits for the user it is no wonder that an increasing number of technology vendors are starting to add this type of capability into their Revenue Cycle and Patient Access products. Healthcare providers are using innovation and forward thinking together to reduce ineffectiveness and ensure that dollars are spent providing better healthcare and not wasted in inefficient processes. It is a winning combination for patients, hospitals and vendors.

Just-in-time Knowledge Distribution Enables the Inexperienced to Behave as Experts

John Mangan , Senior Product Strategy Manager, CiBA

by John Mangan, Senior Product Strategy Manager

Hospital employees who interact with patients during registration have a difficult job. They are expected to gather all the relevant demographic and insurance information, compare it to existing information, interpret the combination, and then make a decision that results in appropriate and compliant actions and behavior. And they are supposed to do all this while remaining calm and cool in what can be a very stressful situation.

You’d think this job would be reserved for experienced experts. Nope. Instead, this job is usually an entry level position given to people with limited or no prior healthcare experience. Also, these positions are not well paid and before the inexperienced gain experience, they often move on to different positions.

The Knowledge is Not Where it is Needed

So for a position that requires an expert the reality is that usually hospitals must rely on a hard working and enthusiastic but inexperienced employee who doesn’t have the necessary knowledge to optimize diverse customer experiences. The critical knowledge exists in the organization, but it is not usually available to those who need it most – the ones on the firing line interacting with patients.

The problem for a hospital is not the lack of knowledge or even inefficient knowledge management, but rather one of inadequate knowledge distribution.

And ignoring this knowledge distribution problem has become a risky, high stakes game for healthcare organizations. Nationally 31% of registrations result in errors. These errors created at the front-end cascade through the revenue cycle endangering reimbursement and increasing rework. The cost of inadequate knowledge distribution is lost revenue, higher operation costs, and diminished patient satisfaction – a toxic trifecta few hospitals can afford in today’s era of tight to nonexistent margins.

Push and Pull Knowledge Distribution Systems are Limited

So how do you take “on-the-shelf” knowledge that resides in the organization and convert it into “actionable” knowledge that can be used by employees who interact with patients? The industrial psychologists talk about two ways to distribute information and knowledge to the employees who need it: knowledge push and knowledge pull systems.

Push systems – like training, e-mails, RSS feeds, blogs and online subscriptions – provide quality information, but the information has no direct relation to what the user is doing.

Pull systems – like portals, search engines, and content management systems – again contain valuable information. The user, however, has to know the information is available and take the initiative to go find it, thereby disrupting the workflow.

With knowledge push and pull systems, employees under the pressure of real time patient interactions can’t get to the exact information they need or are overwhelmed with too much, irrelevant information.

For hospitals, a better approach – Just-in-time Knowledge Distribution

Hospitals, however, are moving beyond the limitations of classic push and pull knowledge distribution systems to lean practices that can deliver relevant knowledge just-in-time to registrars and other patient-interfacing employees when it is needed.

While the just-in-time concept originated with Toyota in its drive to improve its manufacturing processes, this concept can also be applied to the timely delivery of information during registration and pre-registration.

Just-in-time knowledge distribution systems deliver the:

• right information
• to the right person
• at the right time, just in time, so the employee can take action based on that information.

But just-in-time knowledge distribution systems also deliver information in a usable format. It’s not “actionable” knowledge if you have to decipher it before you can use it.

Monitoring Registration Events

To deliver the right information just-in-time when it is needed, you have to know what is taking place on-the-ground, real time. The only way to know what information is needed at the point of patient interaction is to monitor events and activities as they happen. You can’t deliver information that drives the right action if you don’t know what specific information is required. And you can’t deliver what is required if you don’t know what is happening on-the-ground.

Once a just-in-time knowledge distribution system knows what the registrar is doing, then, based on easily configured business rules, it triggers and orchestrates the delivery of the appropriate information or supplies the necessary guidance to identify the information required.

An event may trigger a script that represents the collective knowledge of the organization, a question tree to guide an employee to access the specific information required, or a comparison of newly acquired data with historic data to drive a decision or a desired behavior.

Move Knowledge to Where It Is Needed

Healthcare patient interactions aren’t getting any easier. If anything, they are becoming more complicated as hospitals shift financial clearance to the front end. When you get down to it, you need your patient-interacting employees to react confidently and consistently in even the most unpredictable patient situations. To do this, they need access to up-to-date, task-specific knowledge. This knowledge usually resides in back offices isolated from the patient interaction where it is needed. Timely reimbursement and patient satisfaction depends on the hospital’s ability to move actionable knowledge to the front end where it is needed.

Traditional knowledge push and pull systems just don’t cut it in this fast-paced, dynamic, and complex environment. That’s why hospitals are turning to just-in-time knowledge distribution systems to deliver the specific knowledge that is required for the task at hand. The result: less registration errors, fewer denied claims, and greater patient satisfaction.

John Mangan is the Director of Strategic Product Direction for Cincom Systems. He has solved business problems through automation for manufacturing, financial services, and healthcare organizations for 20 years. Also, he is an active member of NAHAM and HFMA. jmangan@cincom.com

Benefits of adding Cincom Intelligent Guidance to your applications

Cincom Intelligent Guidance helps patient-facing administration staff to navigate through even the most complex admissions scenario and guides them to collect the right information at every point during patient registration. This may very well mean the difference between 100% reimbursement for services and a bad debt write-off. Therefore, the addition of Intelligent Guidance gives your offerings the competitive edge that healthcare administrators are looking for.

By adding Cincom Intelligent Guidance to your existing offerings, you can:

• Win new sales
• Generate additional license and services revenues
• Expand customer relationships
• Remain competitive
• Become even more profitable

Contact Cincom to explore how easily you can add Cincom Intelligent Guidance to your existing offerings.

Intelligent Guidance Technology Can Help Healthcare Facilities Adopt ‘Lean’ Principles

By  John Mangan, Senior Product Strategy Manager.

We usually associate “lean” with manufacturing. That’s because this management philosophy was inspired by the work of W. Edwards Deming at manufacturers in post war Japan and caught the attention of the U.S. by way of Toyota Motor’s manufacturing continuous improvement systems.

However, it’s not surprising that classic lean management principles are starting to permeate healthcare. Eliminating waste, cutting costs, and improving quality (three bedrock lean objectives) will continue to drive healthcare providers in the future no matter what shape healthcare reform takes.

Software with “intelligent guidance” capabilities is a catalyst that will accelerate the adoption and execution of lean principles in healthcare revenue cycle workflows.

 Lean Principles Have Answers for Healthcare

Even though healthcare providers have been slow to accept lean principles, higher costs and lower patient tolerance for inefficient systems will speed up their adoption.  According to experts testifying to Congress, of the $2.5 trillion spent on healthcare each year, 30-50% does not add value to patients.

“In general, health care systems are where manufacturing was in the mid-to late 1980s in terms of lean,” said Jerry McCormick of J.D. McCormick & Associates, a consulting firm that deals with lean systems. McCormick went on to say healthcare is lagging behind other industries in applying lean practices because it traditionally has been focused on doctors rather than patients.

Intelligent Guidance – a tool to apply lean practices to Patient Access

These days, however, the patient’s importance is on the rise. As the healthcare industry adjusts to this new importance, they are looking towards lean principles to help meet their goals and reduce costs. Patient access managers within the healthcare field are finding new technologies with intelligent guidance capabilities allow them to accomplish these lean objectives.

Here are a few examples of how technologies with these intelligent guidance capabilities help those in the healthcare industry meet their goals:

• Cut waste and errors

HFMA reports that on average there is a 31% error rate when collecting patient registration information. That means that almost 1/3 of the patient, guarantor, and insurance information gathered during registration is incorrect.

This incorrect information cascades through the revenue cycle causing havoc for billing, claims management, reimbursement and other processes. At each stage of the revenue cycle someone has to identify and fix the errors that occurred during registration.  And even more troubling, some of these errors are overlooked which can cause denied claims and potential bad debt.

 By using intelligent guidance during registration, patient access managers can prevent these errors from occurring in the first place. They transfer the knowledge required to enter the correct information from the back office to the registrars where it is needed.

• Eliminate extra steps

One of the sacred principles of “lean” is to touch or do something only once. Lean gurus train their disciples to identify and eliminate extra steps that don’t produce value in a workflow, so touching something multiple times is wasteful.

In the past, patient access management has allowed errors to take place, used software to identify the errors after the fact, reported them back to a registrar or supervisor who fixed the errors, and then retrained the registrar not to make the errors in the future. Lean thinking asks the question “Why not prevent the errors in the first place?” Patient Access managers are beginning to use intelligent guidance to prevent errors from occurring during registration. 

• Deliver JIT knowledge

In hospitals, like other institutions, the knowledge required to productively interact with customers at the front end frequently is buried in the back office. The knowledge exists but it’s not always at the right place or in the right form where and when it is needed. The challenge is to deliver the right knowledge to the right person, at the right time, and in the right circumstances. Intelligent guidance enables patient access managers to transform passive, on-the-shelf knowledge into actionable, just-in-time knowledge. 

• Develop your employees

Everyone wants to be successful in his or her job. Lean thinking maintains that instead of monitoring and incentivizing behavior it’s better to build the behavior into the system. Let the system drive the desired behavior. This leads to contented, successful employees.

Intelligently guided technologies insert guides, alerts, and scripts into the registration process when and where they are needed. The system prompts the desired behavior while cutting errors and eliminating waste.

These are just some examples of how savvy patient access managers are employing intelligent guidance to introduce lean practices at the front end of the revenue cycle. Their efforts are paying off in improved patient satisfaction, increased quality, lower costs and improved staff morale.

What is Cincom Intelligent Guidance?

Cincom Intelligent Guidance is a technology accelerator that transforms the healthcare revenue cycle and ensures an immediate improvement to the customer/patient experience by:

• Monitoring all patient, insurance, and other related information
• Interpreting all patient information in relation to the healthcare provider’s processes and rules
• Eliminating data quality and consistency problems
• Providing automated actions or focused guidance every step of the way

Unlike other systems that replace existing Health Information Systems (HIS), the revolutionary technology behind Cincom Intelligent Guidance allows you to extend an existing HIS with easy-to-use, knowledge-driven applications and software services.

Cincom Intelligent Guidance empowers the patient registration and revenue-cycle processes by:

• Prompting registrars with interactive guides – Automated Intelligent Guidance enables you to build the rules that guide registrars and other patient-facing employees through complex registration processes with easy-to-understand prompts and scripts.
• Turning data into information – Automated Intelligent Guidance enables you to not only access the data needed, but also create business rules that customize the information to specifically fit the required registration or revenue-related process of the hospital or healthcare-provider facility.
• Initiating actions when needed – Automated Intelligent Guidance enables you to build business rules to detect key events in the registration or revenue cycle processes, performing a predetermined action when that event occurs.

Contact Cincom to explore how you can add intelligent guidance to your existing offerings.

More information

• Guiding your patient administration team through the admission process
• Existing Applications using Intelligent Guidance
• Case Studies

Five Possible Ways to Use Intelligent Guidance

1) Intelligent Real-Time Alerts – Alerts the registrar to skip to a different stage of the process or change the sequence of the workflow. Easily administered rules drive these actions.

2) Intelligent Real-Time Prompts – Anticipate where errors are likely to occur and have prompts pop up with instructions to eliminate the potential error.

3) Intelligent Format Checks – Catch format errors and direct the registrar on how to correct them, thereby eliminating up to 90% of all errors due to careless typos that may compromise an entire registration.

4) Automated Intelligent Scripts – At selected times during registration, intelligent guidance can pop up a scripted response related to any situation, compliance, policy or patient.

5) Intelligent Registrar Guides – Guides containing an easy-to-understand tree of questions and answers can pup up at any point in the registration process to lead the registrar through a deductive process that results in an automated action.

There are many other ways you may choose to add intelligent guidance to your offerings to optimize and transform the healthcare revenue cycle for your customers. Contact us to explore how easily you can add intelligent guidance to your existing offerings.

Improve Hospital Patient Registration and Bottom Line Financial Results

According to the American Hospital Association 60 percent of hospitals in the United States lose money providing patient care. While that percentage might seem high, it’s even more shocking when paired with the statistic that healthcare providers lose $60 billion a year due to registration errors alone.

The sheer amount of information collected as a person arrives at a hospital is astounding.

During registration, a staff member must collect identification and insurance plan codes. They also have to verify a patient’s insurance eligibility, check their demographic, assess their credit risk, determine if any charity is available, estimate price and much more.

All of this information leads to the creation of a patient’s medical records, which must be accurate in order to provide the appropriate treatment and care. It also directly correlates to the healthcare provider’s ability to estimate costs and collect payments.

Accuracy is an important factor in this process, as one mistake may be a detriment to a person’s health or cause the hospital to not be able to collect on a bill, but it is next to impossible for a healthcare provider to have someone watching over the entire process, especially in turbulent financial times such as these when providers are trying to reduce costs at every turn.

For most organizations, reducing costs means less staff, and very often training is an early casualty. The people who are left are expected to more with fewer resources with little or no training.

The result of a lack of training can seriously impact a business, especially when interactions with customers depend on specialist knowledge and processes to be accurate and provide quality customer service. If a staff member is untrained and unsure how to use a system it has a negative impact on the customer and the business as the quality and accuracy of the data collected deteriorates.

This lack of training is compounded in patient registration as the staff are often entry-level employees working in a very stressful environment where they are expected to register the patient quickly and accurately while also dealing with a variety of systems to get the revenue cycle data collected and into the hospital information system.

Even experienced registrars have to meet the challenge of keeping up with changing requirements and new processes such as estimating the cost of a procedure and learning how to ask a patient to make a payment upfront for a treatment they have yet to receive.

Solving this problem requires creative thinking.

One solution would be to build decision support tools which are integrated into the main registration system. These would provide help and support to the registrar to enable them to register the patient as quickly and efficiently as possible with no errors. To be effective, these decision support tools need to be:

• Integrated with the Hospital Information system to avoid the need for re-keying data once a decision has been reached – an error prone process
• Capable of being updated quickly, as necessary
• Kept fresh and relevant by subject experts instead of IT
• Fast and responsive

And

• A virtual expert that is there when necessary without slowing the system or interaction with a patient down.

For example, if these decision support tools were to be integrated into the insurance verification process – a key part of the revenue cycle that is initiated at registration – an automated message would be sent to the appropriate data source to validate that a patient has a particular insurance plan which is in force at that point. The system would then validate the terms of the plan and establish the patient’s copay amounts which would be sent back to the registrar in a user friendly form. This would automatically prompt the registrar to use the information, and then be guided to the next set of relevant questions in the process.

Innovative systems like this can vastly improve the hospital’s revenue cycle, reduce losses and make money available to be spent where it really matters – providing a better service to patients.