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October 25, 2010

Technology and the Revenue Cycle
By Lee DeOrio
For The Record
Vol. 22 No. 19 P. 5

Media reports may indicate the recession is waning, but don’t tell that to most hospital chief financial officers (CFOs). Theirs is a world where a swirl of regulations and constant tinkering with reimbursement rules make it difficult to stay on top of the revenue cycle process.

Rather than manually dealing with this money-managing maze, some healthcare organizations have opted to employ software packages that can do most of the work, freeing staff from numerous headaches and indirectly improving patient care.

At Hays Medical Center, a 207-bed private, not-for-profit hospital in rural Kansas, the economy, like elsewhere, has been of great concern to senior leadership. CFO and Chief Information Officer Bill Overbey knows firsthand what it takes to keep a facility among the top in its area. Recently, Hays Medical Center was named one of the country’s top 100 best places to work in healthcare for the third consecutive year.

Overbey, who has managed the financial ledgers at Hays since 2001, faces several challenges as the organization tries to retain its lofty status with its patients and employees. His strategy includes utilizing software packages that provide pertinent data available at a moment’s notice. For the most part, it keeps operations running smoothly and staff content that they’re working with the latest technology.

To delve deeper into how Hays Medical Center manages its cash flow, For The Record (FTR) posed several questions to Overbey.

FTR: How do you monitor the revenue cycle?
Overbey: We use various methods to monitor the revenue cycle here at HaysMed. One way would be daily monitoring of A/R [accounts receivable] days by financial class (ie, Medicare, Blue Cross, self-pay). Another monitor is our daily revenue cycle dashboard that reports various high-level KPIs [key performance indicators] related to charges, coding, late charges, cash receipts, clean claims, denials, and inventory of claims in A/R. We are currently developing productivity and KPI dashboards that are meaningful to each employee (specific to their duties) rather than being satisfied with departmental dashboards. The new dashboards will look at much of the same productivity and KPI data but narrow the reporting to the job level. Hopefully this will help every employee to buy more deeply into revenue cycle monitoring and improvement.

FTR: Please explain your billing analysis methods.
Overbey: Initial claim analysis related to charge entry and basic demographic edits is done within our Meditech system. Further claim analysis is done with editing software from MedAssets, which analyzes each and every claim for payer-specific edits as well as NCC [National Correct Coding] edits. We try to watch for clean claim percentages at three different points in the revenue cycle: first when the claim edits in Meditech are applied, next when the claim edits in the MedAssets claims management solution are applied, and lastly when we get the claim back from the payer (ie, paid in full or not).

FTR: How is Hays Medical Center doing in terms of claims denials?
Overbey: We use an automated denial management system. This tool automatically segregates claims not paid in full and allows easy movement of claims between denial management, billing, registration, and coding to facilitate claim correction and submission all within the same claim management system.

FTR: What strategies do you employ to meet medical necessity and timely filing requirements?
Overbey: Medical necessity and timely filing are two components managed within daily A/R management. I don’t believe we have separate strategies to manage these components; it is a part of our daily clean claims management.

FTR: What is your approach to charge capture?
Overbey: Charge capture is a broad area to ask about an approach. This would include processes within our clinics and hospital departments to charge for services rendered through effective use of our Meditech system. One aspect of charging that MedAssets helps with is the use of a rules engine to make sure that we capture all charges related to services rendered. We use MedAssets software to look at charges on every account and analyze if we are missing charges that “make sense” and should be on the account. This software has saved us thousands and thousands of dollars in reimbursement.

FTR: What is your role in ICD-10 planning?
Overbey: ICD-10 planning cannot be done without extensive partnership with vendors. Two of our primary vendors, Meditech and 3M, are integral toward our implementation of ICD-10 changes. We aren’t falling over ourselves trying to make ICD-10 changes until implementation is mandated by the federal government.

— Lee DeOrio is editor of For The Record.