At a glance
Facing unprecedented challenges from Covid-19, a Chicago-based public health network learned how to maximize value by streamlining patient collections and growing its revenue stream. Step-one: a Revenue Cycle Management assessment.
- Worked 52,000 denied claims in 60 days
- Collected $11 million from rebilled claims
- Resolved documentation issues
- Increased physician response rate
A large health network, built on over 100 years of experience, provides high-quality care to more than 500,000 individuals through the health system and its health plan. The network’s doctors, nurses and medical professionals represent the best in medicine. The organization continues to modernize and expand its network of community-based health centers, with convenient locations and a team of experts ready to offer individuals and families everything from wellness care to emergency medicine.
Health network in crisis during Covid
As one of the largest public health networks in the US, the organization meets complex operational challenges to improve care for a large demographic, control costs and comply with
With the effects of the pandemic, the organization needed to implement long-term cost-cutting initiatives to address financial challenges without impacting patient care. Some of these costs could be offset by reducing overtime and slowing the volume of hiring activities. Yet despite these adjustments, the organization was projecting a multi-million-dollar shortfall. Atos was engaged to help determine where departmental processes, specifically in the Revenue Cycle Management area, could be optimized or replaced to drive immediate savings and revenue increases.
As in many healthcare organizations, revenue cycle management is complex, involving multiple systems, teams and critical processes.
Identifying areas impacting revenue and cash collections can be a challenge if left to already taxed internal resources.
Experiencing significant revenue challenges, the organization needed to find a way of optimizing and orchestrating all workflows across the revenue cycle continuum. Engaging clinicians was essential: as key stakeholders in accurate and valuable documentation, it was critical to involve them in the assessment and gain their buy-in to any change.
Areas of focus for the assessment included: Patient Access; Health Information Management – Clinical Documentation Improvement; and Denials Management & Prevention.
Revving the revenue cycle
Atos worked closely with the organization to evaluate how processes, technology and people could be optimized to improve its revenue cycle performance.
In collaboration with the organization’s client executives, key leaders and staff in patient access and patient accounting, Atos conducted an end-to-end revenue cycle assessment to find opportunities for improvements through processes, technology and people.
Atos produced a report including all recommendations, with an implementation roadmap to plan and prioritize all the required initiatives.
The team identified a few select high-impact initiatives that would generate quick wins while fostering collaboration and momentum with clinical and administration teams. These encompassed: Clinical Documentation Improvement (CDI); advisory oversight; denials; vendor management; coding assistance for backlog; and DNFC (Discharged Not Final Coded) /Attestation assistance.
Atos worked with the Denials teams on a 60-day engagement in areas including correct insurance; erroneous denials; communications with Health Information Management and Patient Access; coding conflicts; and trending.
At the start of the fiscal year, Atos’ CDI auditors were deployed to implement reviews, provide staff training, improve accuracy of documentation and coding, optimize reimbursement and ensure the accuracy of reported outcomes.
Improving patient care and financial metrics
The organization accepted Atos recommendations and has implemented changes and enhancements to increase performance against financial metrics without negatively impacting patients.
In addition to IT and automation solutions, positive results from the Denials initiative include:
- 52,000+ claims worked
- 11,000+ claims rebilled
- $11 million in net collections
CDI results delivered include:
- Increased physician response rate
- Decrease in physician query which had doubled in prior fiscal year
- Identification of HACs/PSI (hospital acquired conditions/patient safety indictor) diagnoses and other resolution of residual documentation issues
- Improved revenue