FORT WAYNE, IN – Redesigned processes have helped an Indiana healthcare system accelerate ambulatory care providers’ claims submissions and reduce days in accounts receiveable, thus improving the revenue cycle.
The changes, implemented about a year ago at Parkview Health, didn’t come easily. They required a substantial change in workflow and additional software and communication tools.
A primary goal of the redesigned workflow was to move claims editing efforts from the back end, after claims were sent to patient accounting, to the point when the claim was coded, said Maria Stolze, vice president of health information management for the eight-facility chain.
Parkview was able to reduce the turnaround time for getting medical necessity documentation from physicians to an average of 7.52 days this past April, significantly down from 22.4 days before the change. Workflow changes also brought improvement to the editing of outpatient claims, reducing turnaround to 3.25 days from 30.5 days.
In 2004, Parkview implemented a systemwide clinical software system that required unexpected changes in financial and administrative approaches, said Robert Carlisle, senior vice president and CFO for the system. The implementation of the application, from the IDX Systems Corp., left them in uncharted waters.
“We were implementing things that were just off the drawing board,” he said. “The changes resulted in lack of documentation, missed charges and mass confusion, and I made the decision to stop billing. We didn’t send out bills for 90 days, until I felt comfortable with the bills going out the door.”
Parkview formed a multidisciplinary disaster recovery team to solve the billing crisis, then launched a revenue cycle committee, which eventually began to examine the root causes of billing delays, Stolze said.
The revenue cycle committee focused on ambulatory care, where billing was complicated by complex rules governing outpatient prospective pricing and changing medical necessity guidelines.
The hardest part of moving denials management forward to be handled by medical coding staff involved “integrating people processes with technology,” Stolze said. “We wanted the coding specialist to resolve the edit and, if he or she couldn’t, we needed to refer it to the clinician to resolve it.” By the time Parkview finished revamping workflow, it found 86 scenarios that needed to change to facilitate outpatient billing.
“We knew we were rocking the coding specialists’ world,” said Brenda White, who led the project for Parkview. “We had to engage them in the process. This was a much bigger process than we knew.”