Improving Operational Efficiency by Eliminating Redundancy

Internal processes within larger organizations may seem to be flowing like clockwork, just like it has for years. Every person in every department knows their role and is careful not to overstep their defined internal boundaries. However, as organizations grow and implement different technologies to improve efficiencies within each respective area, unnecessary redundancy in processes can create an expensive roadblock that can negatively impact organizational performance and financial success. Understanding the full bandwidth of potential technology implementation and having clear communications between departments is essential to streamlining workflow, increasing efficiency, and reducing cost, thereby increasing revenue. However, in many organizations, the right hand rarely knows what the left hand is doing. A matrix of all deployed technologies and a full understanding of each system’s applicability across all departments is a helpful start. If there’s a process that seems similar throughout multiple departments, there’s likely a process rework or technology solution that would help.

Below are two scenarios encountered with a recent Coker Group client. Both processes were successfully updated to utilize solutions already deployed in other departments of the hospital system. In full transparency, the Coker senior manager assigned to this interim revenue cycle management project had previous experience with other systems and interfaces, which made this situation a bit easier to diagnose and correct.

Payer Enrollment and Credentialing, Client X - Hospital Physician Group

• 200+ physician and non-physician providers (ambulatory, hospital-based, school-based, urgent care)
• Recent network growth spike increased the size of the network by 25% in the previous 18 months
• One payer enrollment specialist to manage all CAQH, Medicare, Medicaid, payer applications, and provider contracts
• No electronic enrollment software deployed in the physician group
• Minimal experienced and skilled local staffing resources

The redundant processes:

• The medical staff office required a handwritten application from each physician/provider.
• The physician group required CAQH, Medicare (PECOS), and several other non-CAQH applications, private payer contract signatures.
• Hospital’s Human Resources required a separate physician/provider application.
• Physicians/providers were required to submit multiple handwritten and/or electronic applications, all provided independent of each other, but with the SAME demographic information.

As the group continued to grow, the enrollment specialist was stretched thin to the point of looking for other employment options. The loss of this staff member would be devastating for this growing network. Because the senior manager had previous experience with additional enrollment and credentialing technology, a random “contact us” email to a national vendor resulted in the discovery that the client had been using the medical staff credentialing module of the software for years. After viewing the demo, meetings were scheduled with the medical staff office and other leadership to convince them the product the hospital had could be used by the provider network and even by HR to capture the necessary demographic information once and shared by multiple internal departments. The bonus: the incremental cost of adding the payer enrollment module was minimal since the basic setup was in place. The project was delayed because an upgraded version became available, and this additional expense had to be vetted and approved in the annual budget, which had just closed the prior month. Organizational red tape is sometimes the root of all evil.

It was a win-win-win-win!

• The credentialing specialist was ecstatic at the thought of eliminating some unnecessary steps in her manual and outdated process.
• The medical staff office, though still a bit skeptical, was more than willing to collaborate more closely with the credentialing specialist to improve the process.
• Human resources became interested in trying to use the single application to meet their needs.
• Because the medical staff office does primary source verification in their approval process, there is also an opportunity to pursue approval for delegated credentialing. This would allow providers to be approved by those plans that accept delegated credentialing, cutting that process to days instead of months.
• The biggest winners were the physicians and providers, who will no longer be required to submit multiple applications with the same basic information multiple times.

Hospital Charge Reconciliation

‍This same provider network had a large group of hospitalists and specialists, turning in handwritten cards with billable services indicated. All this was satisfactory as long as there is a level of confidence that they turned in ALL cards. The billers and coders would frequently discover documentation for visits and services that were never billed (OB deliveries, specialty consults, follow-up visits, etc.). The coders had worked with one of the hospital data analysts to develop a rudimentary report to help them identify patients assigned to each physician working in the hospital, but it lacked any actual encounter detail. Again, the consultant had recently worked in a hospital system with the same electronic medical records and billing systems. Thus, she knew of a better interface solution that would virtually eliminate the monthly manual process of matching handwritten billing slips to a report that only showed patient names.

Three hospital analysts worked with the physician billers/coders, which would identify each patient encounter by the provider. Before the end of each month, the billers email the providers a list of every documented encounter still missing submitted charges. Then the coders spent countless hours reading hospital notes just to identify the separate encounters with no reconciliation of all services provided. As new providers are added to the group, the analysts are notified to add them to the reporting process, so those encounters are tracked. This action has resulted in approximately $75,000 to $100,000 more charges per month that would have been missed with the previous report, which was difficult to use and was not set up with all service lines represented. It required multiple people to review it manually, and there was no provider accountability to complete records and charges promptly.

Win-Win-Win

• The coders have a heads up that there was an encounter or service. They aren’t just finding missing charges by luck.
• Superb collaboration between the physician billing department and the hospital analysts that now look for other opportunities to identify missed revenue, such as minor surgical procedures and billable non-physician charges in the hospital.
• The physicians and providers are promptly informed that charges are incomplete.
• By identifying these missing charges, the physicians are can be held accountable to get these records completed and charged within the hospital timelines (or face potential fines or medical staff suspension).
• The physician group increased charges by $75,000-$100,000 per month!

Whether internal or external, systems and processes must continually be assessed and updated based on current technologies and opportunities. Recognizing and challenging the status quo isn’t always easy coming from the inside. Sometimes the eyes and opinion of an outsider offer a more significant benefit since they are typically aligned with a limited scope of the project without the barriers of impacting internal relationships.If you’d like to learn more about how our Physician Services team can support your EPN, please contact us today.