ADVANCE for Executive Insight 1 ADVANCE for Executive Insight

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evenue cycle Certain problems and challenges are common across healthcare providers regardless of process design, so it’s important to learn from others and avoid reinventing the wheel. revenue if not resubmitted, but also in terms of the labor required to research, correct, and re-submit claims within the time limit. Consider implementing scrubbing tools throughout the process--the sooner errors are caught, the easier they are to resolve. On the Web To view an archived webinar on Revenue Integrity, go to the webinars section at www. advanceweb.com/executiveinsight coding and billing staff to “just fix” problems or invent special exceptions instead of suggesting process improvements. • How many human touches does the standard process require? This is a count of the actions of personnel (whether a physician, a biller, or other staff member) throughout the cycle. Every touch is an opportunity for delay or error, so it’s important to know how many there are. While you’re at it, also identify the typical time duration of each step in the process. • What is the ideal time-to-bill? What is the average? If everyone completed their tasks as soon as possible, how long would it take for a claim to be submitted? This number isn’t zero because of externalities and each touch by its nature having some friction. By comparing these ideal durations with the real-world averages collected earlier, you can get a sense of the major slowdowns and lags in the system. Resolving Common Problems Certain problems and challenges are common across healthcare providers regardless of process design, so it’s important to learn from others and avoid reinventing the wheel. Specifically, examine: • Habitual mis-coding (E&M Levels, Expired Codes, etc.) This is an issue that coding and billing staff will often inadvertently obscure by diligently correcting errors habitually created by a physician. Consider providing (regularly) a combination of peer comparison data, code pick list updates, and feedback on common errors to physicians and other clinicians. • Non-compliance with Local Payer Requirements Denials are expensive not just in terms of lost Missed Charges This is the “elephant in the room” of process challenges, especially for the inpatient environment. Reconciling outpatient schedules with charges received is a mercifully straightforward process built into most practice management systems. Inpatient charges are much more difficult to manage, but electronic tools exist for this as well. Paper-based reconciliation is possible but (due to its labor intensity) best applied as a rolling audit and not a universal standard. Raising the Bar Creating an organizational culture of continuous improvement will not just prepare a provider group for overcoming future issues but also increase revenue and compliance in the present. This is best achieved through a series of steps. First, deliver a clear message to the organization about the key metrics of global performance, their current status, and group-wide goals for improvement including target completion dates. High-achieving healthcare personnel (like physicians) often respond positively to clear, concise communication about “where we are” and “where we need to be.” Next, create as much transparency to individuals as possible about their own performance. Individualized reports and performance dashboards (if you can provide them) will greatly aid this effort. In some cases it may also be appropriate to link compensation to individual performance metrics. Pair these global and individual metrics with educational resources. In general, you’ll want to offer a mix of group courses with targeted, individual training. For example, your metrics may reveal that a particular coder is struggling with complex surgical charges and needs targeted assistance with surgical coding. Finally, increment your goals (“raise the bar”), and repeat the process. For some groups or smaller goals, it will be appropriate to iterate quickly over just a few months. Others will find that an annual program of improvement is a better fit organizationally. 40 ADVANCE for Executive Insight
telemedicine Mercy Health has found telemedicine to be an effective way to enhance patient access to care, resulting in improved patient outcomes and decreased costs. scott frymoyer/jeff leeser Reimagining Patient Care Telemedicine brings patients and providers together. By Wendy Deibert Wendy Deibert is vice president, Telehealth Services at Mercy Health. In response to evolving changes in healthcare, hospitals and health systems are beginning to think outside the box when it comes to the best ways to deliver quality care and keep costs in check. One approach gaining traction is telemedicine—using telecommunication and information technologies to provide healthcare from another location. Mercy Health has found telemedicine to be an effective way to enhance patient access to care, resulting in improved patient outcomes and decreased costs. Why Telemedicine? Mercy Health serves more than 3 million people across Arkansas, Kansas, Missouri and Oklahoma. Approximately 90 percent of the counties served by the organization are rural, presenting challenges in fostering patient access to care. We believed that telemedicine could overcome some of these difficulties, conveniently bringing patients and providers together. Our first foray into telemedicine began in 2006 when we went live with a tele-ICU program. Prior to this, we had intensivists in only one of our hospitals: The intensive care units in the other hospitals were run by consulting physicians, some of whom were not specialized in critical care. Our goal was to provide the same level of care throughout all our hospitals, and that meant we had to find a way to leverage the expertise of our existing intensivists. Research shows that ICUs with intensivists at the bedside offer better quality care in terms of lower length of stay and decreased mortality. Within 18 months of starting the tele-ICU program, Mercy brought 350 tele-ICU beds online with each bed hardwired to a wall-mounted video monitor. Through this technology, we were able to have constant intensivist coverage in each ICU. In addition, experienced critical care ADVANCE for Executive Insight 41
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