Hospitals invest countless hours in the financial and operational functions that support direct patient care. Administrative requirements from payers, government regulators and other stakeholders increase spending and drain limited hospital resources.
Information systems that capture and centralize communication can substantiate these efforts, while also streamlining business processes. Staff can use such systems to document any exchange – phone, fax, Web or email – related to routine processes such as scheduling, eligibility, benefit and authorization.
At West Jefferson Medical Center, our initial goal for this kind of technology was to improve efficiency by streamlining communication processes.
We started by recording clinical information given to payers by phone. If payment is denied, the business office retrieves the recording and plays it back to verify medical necessity.
With proof to back up our exchanges, we reduced our medical necessity denials from $716,000 to less than $50,000, resulting in a gain of more than $650,000. By establishing credibility with payers, the documentation helped us prevent denials and sustain ongoing improvement.
We expanded the communication management system to remove subjectivity from he-said, she-said scenarios across the organization. Managed care contract negotiations, for example, are recorded to resolve discrepancies surrounding contract terms and interpretations.
West Jefferson has also used the system to streamline administrative duties surrounding patient care. Faxed physician orders, for example, were previously misplaced or difficult to locate when needed.
By electronically archiving and routing orders to appropriate departments, staff can now easily locate records when patients present for service.
Medicaid notification, required within 24 hours of admission, was a manual process that drained registration of time and valuable resources.
Misplaced, illegible and undeliverable forms added to the administrative burden and caused lengthy delays in payer responses. Notification forms are now auto-populated and delivered electronically through web-based technology.
A permanent record of routine exchanges improves our ability to manage quality and customer service. By monitoring communication records, leaders can establish accountability to ensure appropriate communication with patients, physicians and other providers.
Proof of routine communication is an effective defense of the time and resources hospitals invest to sustain quality patient care.
When a provider has done everything it possibly can to protect itself, a communication management system provides indisputable evidence in support of its efforts. By leveraging this communication, providers can better protect themselves and the patients they serve. n
Angela Greener is chief administrative officer of West Jefferson Medical Center in Marrero, La. The hospital uses TRACE by the White Stone Group to manage routine communication across the revenue cycle.