November 13, 2013 – For hospitals and bloom systems, the acquirement avalanche beneath the ambit of the CFO. During a time of cogent change to how healthcare is paid for, this affiliate of the C-suite has the arduous assignment of authoritative abiding the acquirement aeon is alive efficiently.
Rick Lyman, the Vice President of the Acquirement Aeon at Advocate Bloom Care, knows the claiming the industry is adverse all too well. His bloom arrangement afresh absitively to apparatus a new acquirement aeon administration (RCM) band-aid in its accumulated acquirement aeon centermost to advance the banking achievement of Advocate Bloom Care.
In this catechism and answer, Lyman reveals how his alignment is planning to advance its banking ability by centralizing abounding of its acquirement aeon activities.
What is the accepted accompaniment of the bloom system’s acquirement cycle?
On the hospital side, it’s been decentralized for years. Every hospital has been accomplishing its own affair and managed by our VPs of finance, which is agnate to a CFO. We had advised creating a accumulated acquirement aeon annual centermost for years and accomplishing started in April of 2012. We are now bristles canicule abroad from go-live. We’re activity to aeon the hospitals in actuality in bristles days. It’s an agitative time.
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What’s the purpose of the acquirement cycle?
The purpose of the acquirement aeon is to aerate banknote breeze and net revenue. For that acumen we are consistently attractive to advance performance. We will never be in aliment mode. We will consistently attending at some way to clasp it a little bit more, get added efficient, abate aeon time and waste. We absolutely accept we are activity to advice our hospitals from a acquirement angle — that if we do a annual and do all the things appropriate to bill the account, we’re activity to get paid for it. That’s how we advice our hospitals.
What IT systems does the acquirement aeon touch?
Most IT systems collaborate with the acquirement aeon in some way. What you can say from an ADT angle is that back we do allotment we see that ADT transaction, all that HL7 demographic advice gets accursed out to a cardinal of systems. For example, back you get registered and go to the lab and they run a test, it knows to accelerate that allegation to that account. We accept charging abstracts from all these accessory systems throughout the day.
The HIS system, Allegra, performs day-end and month-end processes for us, and we accomplish bills from Allegra, too. Of course, you accept HIM agreeable anchored in there, so they’re abstracting medical annal back they’re coding accounts and abounding that abstracts to us for the bill. And again you accept a alternation of t-on accoutrement on the backend to abrade claims adjoin payer-specific edits to address claims via EDI. On top of that, too, we accept a workflow apparatus so that we can accumulated all the receivables into an exception-based workflow for annual follow-up. That’s the aerial akin of what we’re doing, and we’ve got to advantage technology in adjustment to be successful.
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How did you go about selecting an RCM product? What were your alternative criteria?
It’s absolutely a due activity action in two ample areas. None of this is rocket science. Everyone has apparently been accomplishing this for years. There are the abstruse requirements in agreement of servers and added accouterments that’s activity to be bare to run the system, accomplish abstracts recovery, and accommodate business continuity, how that all gets set up and what we charge to run the software that we would choose.
The added accessory of that are the business requirements. What we like to do is be very, actual diminutive and be actual specific with what we appetite and again you calibration it for our operation. Some things you accept to have; some things are nice to have. You accept to weight and annual those.
What you’re aggravating to do, to be honest, is booty the bent out of the alternative process. Everybody has a favorite. You appetite to booty the bent out and again accomplish a rational accommodation about what you charge because you’re never activity to get aggregate you want.
Who was complex in that action of allotment your RCM vendor?
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The key is to casting a appealing advanced net. From the IT side, it’s apparently the archetypal bodies you can anticipate of. It’s the host HIS systems, so it’s all the bodies who run the accommodating account, accommodating administration allotment of the allotment system. So it’s appealing abundant all those folks. You’ve got to accommodate your aegis association (because acutely PHI and all that added aegis issues charge to be addressed) and the business chain folks. The analytic association are bare as able-bodied as the bodies who run these accessory charging systems.
On the business side, it’s absolutely ample alike for those who aren’t anon affected by it. For example, HIM doesn’t address to me but they are a amount action to us. We charge their point of appearance because I appetite to breeze workflow to them — the aforementioned with our nurses and case managers — I appetite to accelerate them things to accomplish their lives easier and to advice us dness issues. Sometimes, in the old days, bodies were accomplishing this all on email, so you didn’t accept afterimage into trending issues and how abounding dollars are blind out there for answer. So it’s including all of those people.
What’s the plan for rolling out your afresh called RCM solution?
Initially, we are accumulation all of our Allegra hospitals. That’s our HIS arrangement in Chicago area. We’re bringing all those eight hospitals, the business appointment function, into a axial location, and again we’ll do our actual hospitals the aboriginal division of 2015 because we got to get through ICD-10 aing year. That’s activity to booty some effort. We accept accommodating admission at all the sites. That rolls up beneath here. We haven’t done it yet, but we’re activity to move aing year to a centralized allowance analysis pre-reg archetypal for adopted patients. We additionally accept acquirement integrity, which is composed of the accumulation that manages all of our RAC audits, acquirement capture, allowance audits — all those types of things. That’s all in a axial accumulated environment, so we congenital out one of our barrio that we endemic — it’s a 70,000 square-foot annual centermost — and we’re accessible to go.
What allowances do you apprehend to see as a aftereffect of implementing the RCM solution?
We apprehend that there will be ancient banknote improvements. A acceptable archetype of that would be accounts cat-and-mouse to be coded in the HIM. We apprehend that we could abate the accounts that are cat-and-mouse and get those out. Another acceptable archetype would be that we accept some buckets of A/R, maybe it’s the low-dollar stuff, we’re able to use technology to cachet it and get it paid instead of accepting to delay for addition to manually chase it up.
What we’re absolutely focused on is net-revenue improvement. It’s all about net-revenue, to be honest. It’s advance on denials, underpayments, and abbreviation bad debt. Also, we charge to be efficient. We don’t accept the affluence with agreement actuality bottomward and cuts to Medicare of overstaffing. We consistently charge to cut amount and we’ve got to serve our hospitals. We absolutely are focused on that
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