We get to work with some amazing customers on tackling some of their toughest challenges. There isn’t a one-size fits all solution out there, but we do think the recipe for success always involves data, analytics, and the right people with EHR and industry expertise. Over the next few weeks, we will be sharing some recipes for success with revenue cycle strategic engagements. The blogs will follow STAR, our favorite structure for reporting on successes and challenges:

• Situation
• Task
• Action
• Results

In our first case study review, we look into a scenario where we were tasked with increasing transparency and communication between managers and leadership

Situation

The physician group we partnered with needed a way to increase transparency into their revenue cycle metrics and better understand potential bottlenecks creating delays in their billing cycle.  They needed to overcome hurdles in requesting data and resources from internal teams to help them identify and monitor key performance indicators (KPIs) to effectively and efficiently communicate process and problems between management and leadership.

Task

Our team of revenue cycle experts were tasked with:

• Consolidating and refining the goals presented by their leadership and management groups and translating the goals into measurable KPIs
• Centralizing and standardizing KPI definition
• Aggregating data
• Designing data drilldown paths
• Defining benchmarks and thresholds for alerts

Using all the information and input provided throughout the above steps, we identified potential bottlenecks and areas for improvement.

Action

We created an application that monitored revenue through its various stages in the billing process, from initial posting, through coding review, and on to billing and collections. We designed the application to allow the user to identify trends within their revenue capture and collections at the physician, department, bill area, financial class, payor, and provider level, and to identify bottlenecks where revenue was being held in a coding review workqueue.

Result

By combining the trifecta of governance, data and industry/EHR expertise, we delivered a tangible product that included:

• Centrally agreed upon metrics and a scoreboard
• Access to integrated data previously not available
• Indicators to potential system, resource or payor problems
• Proactively alerted managers of issues in their billing cycle

The application allowed users to drill into bottlenecks within their revenue capture process and they were able to identify over $2 million being held in a workqueue for a single physician and bill area. By allocating staff to work with this physician to improve their charge capture process, they were able to fix the issue causing revenue to be held and reduce the lag time to submit claims for that physician. This lead to a faster billing cycle and increased collections for the organization.

Are  you interested in hearing more? Please email us at:  prominencesales@prominenceadvisors.com