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Case Study: Lowell General Hospital’s Journey to a Paperless Revenue Cycle Lowell General Hospital.

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Presentation on theme: "Case Study: Lowell General Hospital’s Journey to a Paperless Revenue Cycle Lowell General Hospital."— Presentation transcript:

1 Case Study: Lowell General Hospital’s Journey to a Paperless Revenue Cycle Lowell General Hospital

2 Presenters Bill Wyman, Director of Revenue Cycle Sandra Clay-Hillyard, Pre-Services Manager, Patient Access Michael McAuliffe, Revenue Cycle Management

3 $ Case Management Authorizations Verification of Benefits Eligibility Notification of Admission $ MD Orders Notification of Discharge MD Office Communication Managing Communication is Complex! $ Precertification Customer Service Call Center Concurrent Review Physician Query Patient Patient Instructions Financial Counseling Important Message Read-back Instructions Patient Satisfaction Calls Call Monitoring & Training Patient Status Changes Pre-registration Calls Scheduling Verification Patient Out-of-Pocket Instructions Pharmacy Benefit Eligibility Verification of Precert Billing Inquiries Payer Hospital MD Office

4 Protect. Prove. Perform. Protect Revenue. What really happened? Where is our opportunity? Prove Compliance. What went right? Provide staff support. Drive Performance. Fix broken processes. Streamline workflow.


6 About Lowell General Hospital Patient Highlights Staffed Beds 179 Inpatients discharged 15,693 Patient days of care provided 53,537 Births 2,371 Diagnostic imaging procedures 147,223 Laboratory procedures 1,163,440 Surgical procedures 10,393 Radiation therapy procedures 11,610 Emergency services 48,931 Outpatient clinic visits 27,559

7 Revenue Cycle and Integral Partners Patient Access – Central Scheduling – Pre-Registration – Financial Clearance Unit – Ambassadors – Patient Service Centers Patient Accounts Patient Financial Services Imaging Services Continuity of Care

8 Revenue Cycle Opportunities Physician Orders Patient Experience/Customer Service Billing/Denials

9 Physician Order Challenges Lost Orders Miscommunication The Paper Chase Denials $$$$

10 Brian Bailey – Manager, Ultrasound Services

11 The Solution Orders received electronically Indexed to real-time patient data Available to all users at any time

12 Custom Fields Custom fields established based on workflow Examples – Insurance Group – Physician Offices – Service Lines – Inside/Outside Referrals All fields are searchable

13 Fax Messages

14 Results Streamlined workflow Increased productivity Physician satisfaction Customer satisfaction

15 The Silver Lining

16 Patient Experience Challenges No proof The blame game Delay of care Scheduling discrepancies Confusion about instructions Complaints

17 Goals Minimize delays Eliminate patient reschedules for lost orders Maximize positive customer experience over telephone Timely account satisfaction

18 Call Monitoring Professionalism – Attitude, friendliness, communication skills Technical knowledge – Ability to complete requested task Compliance – HIPAA, standards of performance & behavior Customer satisfaction – Experience of: patient, doctor’s office, insurance company, staff member

19 Anabella Silva – Supervisor, Central Scheduling

20 Voice Recording Options – On-Demand – Automatic – Face-to-Face Scenarios – Scheduling – Registration – Pre-Authorization – POS Collections

21 Results Improved QA process Customer service improvement Staff support Improved patient throughput

22 Denial/Billing Challenges Communication with payers – Pre-authorizations – Admission notifications Communication between clinical areas and revenue cycle

23 Admission Notifications No proof of notification No documentation of sender Denials

24 Carol McGowan – Supervisor, Financial Clearance Unit

25 Medical Records and Billing Slow, inefficient process Explored options for necessary improvements New process developed – Streamlined and paperless

26 Deb Psaledakis – Accounts Receivable Rep

27 Results Reduced net days in A/R Reduced denials Ammunition to appeal Improved POS collections

28 Where are we now?

29 3 successful deployments Infused revenue cycle initiatives into clinical areas ROI

30 Areas of Expansion Cancer Center HIM – Coding, Release of Information Outpatient Nutrition Endoscopy Ambulatory Care Unit – Day Surgery Pre-Screening Operating Room Scheduling Pain Center Satellite Surgical Center Cardiology Sleep Lab Center for Weight Management HIM Audit Support Merrimack Family Medicine

31 Q&A Bill Wyman, Director of Revenue Cycle Sandra Clay-Hillyard, Patient Access Michael McAuliffe, Revenue Cycle Management

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