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A recent Black Book survey of more than 500 healthcare networks revealed that hospitals in the U.S. have been painstakingly slow in adopting healthcare revenue cycle management (RCM) solutions. At the start of 2018, nearly 26 percent of hospitals had no viable solution in place, and 82 percent of them planned to make value-based reimbursement decisions without one. For most hospitals, one of the biggest challenges in implementing RCM solutions is finding talent with the right skill set to handle RCM software difficulties. It’s a problem that even the largest healthcare delivery networks face and one that UCLA Health hospitals had to overcome. UCLA Health System Faculty Practice Group (UCLA FPG) employs more than 2,500 physicians with more than 220 primary and specialty practices. Keeping up with payer contracts In 2007, more than $4 million in revenue went uncollected at UCLA FPG. The group’s RCM pain points were typical of those in the industry. For example, the group was unable to keep track of over- and underpayments, which made it difficult to adhere to payer contracts. It was also difficult to manage appeals and track recovery as the volume of payer contracts grew and became increasingly more complex. The difficulty UCLA FPG had in gathering and exporting information, in addition to the complexity and volume of contracts, left it with little negotiating power when dealing with payers. UCLA FPG\'s numbers continued to fluctuate until implementing Epic alongside Experian Health\'s Contract Manager. Using this web-based solution, UCLA FPG has been able to automate and improve its revenue cycle due to the solution’s ability to continually monitor and update every payer contract. This has also helped the healthcare group stay compliant with all payer agreements by making it possible to catch errors faster. Director of Revenue Integrity Measha Ford states: “We are able to catch Medicare overpayments faster with the contract management system. We recently integrated all our Medicare contracts into the system to have a lower risk of compliance issues since we only have 60 days to refund Medicare back once we identify an overpayment. Having this system, having that ability to load the contracts into the system to catch these potential risks, is very helpful.” The UCLA network now has fewer administrative write-offs every year, faster AR collections, and reduced denials. Experian Health\'s team maintains contract terms, fee schedules, and payment policies and makes sure every claim processed follows UCLA\'s contract terms. Online dashboards and reports help monitor reimbursement and reduce payment discrepancies through interactive graphs that expose source claim data and practice management system-specific data attributes. Analyzing contracts before signing up In addition to tracking and managing contracts, the group also knows exactly how a new contract or redefined contract terms will affect its bottom line. It has intel on real-world “what if” scenarios to provide insight into how various contract terms affect cash flow for the precise mix of services the group provides. It\'s also able to avoid unfavorable contract terms, as they are easily spotted through analysis. Are health plans complying with your contract terms? Learn more about how we can help you find lost revenue with data-driven insight.
Healthcare organizations have been forced to deal with billing challenges for so long that many might consider the struggle to simply be the price of doing business. Denied claims and contractual underpayments are regular occurrences in the payment cycle. And these issues can cause problems in the rest of the healthcare ecosystem when left unchecked. Fortunately, a robust claim scrubbing solution can reduce costs and speed up reimbursement. Healthcare billing costs can add up quickly. The estimated cost of billing- and insurance-related jobs at one large academic healthcare center ranged from $20 to $215 per patient visit, according to a study published in 2018. For years, the State of Franklin Healthcare Associates (SoFHA) was all too familiar with the challenges of the claims process. In 2010, the organization had to keep 12 full-time employees on its payroll devoted to the correction and resubmission of denied claims. When claims are denied, Crowe reports that it takes an average of 16.4 additional days for a hospital to receive payment. And those delayed payments are costly to healthcare organizations. Without the tools that enable a proactive approach, healthcare organizations\' only option is to submit claims and then wait to correct the ones that are denied. SoFHA’s large network of 109 providers included a wide variety of specialties and services, from diagnostic imaging and internal medicine to OB/GYN and family practice. SoFHA needed a flexible presubmission claim scrubbing technology that would identify and correct errors before claims could be submitted. To overcome the obstacles in the claim submission process, SoFHA turned to Experian Health\'s Claim Scrubber. Claim Scrubber stood out to the group in two ways. The first was the price, as users pay a fixed monthly rate rather than pay for each transaction. The other highlight was the ability to build customized claim edits, which are available to all clients immediately when the tool is deployed. For Amanda Clear, SoFHA’s director of business services, that capability made all the difference. “With Claim Scrubber, I have the ability to go into the system and create my own edits,” Clear said. “Other systems either didn’t accommodate customized edits or required you to call, perhaps pay a fee, and go through a long process.” Plus, Claim Scrubber reduces demands on healthcare provider personnel because the tool comes with around 350 edits maintained by a dedicated content team. Payer-specific edits replace between 60 and 75 percent of an organization’s custom edits right away. Claim Scrubber ensures claims are correct and complete the first time they\'re submitted. Experian Health regularly updates its system with coding and payer changes. The tool adjusts for coding variances on claims submitted to Medicare, Medicaid, and private insurance companies. It reduces denials and drives down rebilling costs for healthcare organizations. With Claim Scrubber, SoFHA generated a clear return on investment, and the group was able to expedite accounts receivable by 13 percent. Perhaps even more telling was the reduction in full-time claim correction employees that accompanied the adoption of Claim Scrubber — a change that occurred in spite of a growing volume of claims. By auditing claims and spotting errors before submission, Claim Scrubber can ease the burden of claims denials and allow healthcare providers to instead focus on their job of providing the highest-quality patient care. --- Learn more about how we can help you ensure all claims are complete and accurate before submission to the appropriate payer or clearinghouse.
The United States’ health system has become the most expensive in the developed world, and high administrative costs are a big factor. They account for more than 25 percent of spending on hospital care, making American healthcare administrative costs higher than any other country. Much of the problem comes from the complexities of payment. With public health programs, private insurers, and patients themselves all splitting the bill, it’s difficult for hospital administrators to determine who pays what in each situation. Especially during patient registration, they are bogged down by the time-consuming process of verifying patients’ eligibility for insurance and other programs. For these reasons, Martin Luther King, Jr. Community Hospital decided to focus on improving its patient registration process. The private nonprofit safety net hospital in South Los Angeles serves a high-need community and sees about 300 patients per day. Manually checking in all those people meant that MLKCH’s administrative team had an overwhelming workload. The hospital needed an integrated solution. Automation simplifies hospital patient registration The hospital’s staff was spending a significant amount of time checking different payer websites and making phone calls to determine each patient’s eligibility for insurance and various programs. Then, the benefits information had to be copied and pasted into the hospital’s non-integrated platform, which was another slow process that often resulted in inaccuracies. Quality assurance to find and correct those errors was a manual process, too, taking up more of the administrative team’s bandwidth. To free up resources and reduce errors, the hospital wanted to automate its verification processes, streamlining its registration, quality review, and more. MLKCH also needed its hospital patient registration software to work well with the Cerner system it already used. It decided to implement Experian Health’s eCare NEXT® platform. “We decided to use Experian Health’s software within Cerner versus a couple of the products we were looking at, at the same time, because it truly integrated within Cerner,” said Lori Westman, patient access manager at MLKCH. “When we presented this to our CFO, he liked the fact that it was integrated within Cerner; he didn\'t want us to have to go out to another third-party payer to pull information back. It\'s all about time and the time we can save on our registrations. That was the biggest selling point — the integration within Cerner and its seamless registrar on the back end. To the team, it\'s just another program they\'re working with in Cerner.” The software from Experian Health automates registration and financial clearance, among other patient access processes, which account for up to 80 percent of manual preregistration tasks. The system assesses patients quickly, replacing the information-gathering that staff has traditionally done. For MLKCH, which sees many returning patients, if a patient is already in the system at check-in, eCare NEXT pulls up his or her eligibility automatically when an administrator accesses the account. This saves several minutes, making it a notable patient registration process improvement. The system also eliminates a large portion of redundant tasks. When using the platform to check eligibility with one plan, eCare NEXT also searches for other applicable plans. For example, MLKCH treats a large Medicaid and managed care population, so checking a patient’s eligibility required visits to both the state’s and the health plan’s websites. But eCare NEXT will verify both automatically. Additionally, the fact that eCare NEXT integrated seamlessly with Cerner has improved the hospital’s patient registration process. Because the two platforms work together, patient data has become more accurate and the quality assurance process is less cumbersome. MLKCH was able to implement new QA standards after staff became familiar with the automation tool. The team also found that the enhanced data from eCare NEXT can shape user education and pinpoint areas for further improvements. And while there were some concerns that a new platform would take a long time to adopt, the rollout of the patient registration system was smoother than expected. The administrative team got a robust solution with exceptional support to ensure users have every resource they need. Ultimately, implementing an automation tool eliminated MLKCH’s most time-consuming registration tasks, allowing staff members to focus only on the tasks that needed their attention. This made their jobs easier and more efficient while also reducing training needs and improving compliance. The registration process became much faster. Automating preregistration tasks and eligibility verifications has also ensured MLKCH’s administrators have more accurate eligibility information. This integrates with Cerner to increase the quality of patient records. But the most important benefit of improving the patient registration process has been how it affects patients. These time savings get passed on to them in the form of quicker registration and less hassle proving eligibility. Using eCare NEXT has not only helped the hospital\'s administrators, but it has also allowed MLKCH to enhance patient service. Westman adds: “We get fewer denials because we\'re getting true verification data, and our patient volumes continue to increase. So the fact that we can take off two to three minutes, at least, on half of our registrations is speeding up the work for the team, and the turnaround time is much better for the patients.” Need to streamline your patient access department? Learn more or schedule a demo with us today.
The burden of healthcare expenses on patients is a growing problem for hospitals and patients alike. Hospitals are losing about $7.5 billion in out-of-pocket medical expenses that go uncollected every year. And collecting patient balances has become more difficult largely because patients are struggling to keep up with rising medical costs. Insurance reforms that have produced higher copays, among other things, are putting a greater financial burden on patients. They are now expected to cover about 30 percent of medical treatment costs, but many cannot afford it. In fact, high medical expenses factor into two-thirds of bankruptcies. This means that as more patients struggle to pay for healthcare, the amount of bad debt hospitals have is rising. In a survey of 100 hospital executives, 36 percent reported that their systems had $10 million or more in bad debt. And their prospects for recovering that money are grim. The issue is that many healthcare networks don’t have the technology to handle their complex collections challenges. Martin Health System was seeking a solution to automate its collections processes for self-pay revenue. Based in Florida, the healthcare network has three hospitals and numerous outpatient clinics, as well as an emergency center. That translates to a lot of patient accounts to evaluate. Martin Health needed healthcare collection software. Optimizing healthcare collections Hospitals need to be able to analyze their records to determine which patients are most likely to pay. The right software makes that process more efficient and effective so healthcare organizations can improve their collections outcomes. Martin Health System had already optimized its registration and authorization phases but system leaders felt that it could further enhance collections efforts with an automated solution. In 2016, the network implemented Experian Health’s Collections Optimization Manager. The top priorities were segmentation, identifying charity cases, scrubbing for Medicaid opportunities, and better collection agency monitoring and management. The self-pay receivables management solution automates many aspects of healthcare collections using data analytics. Martin Health was able to optimize its collections efforts by determining how to allocate resources more appropriately and place accounts with the group best suited to collect for each account. To create a more compassionate experience, the software culls through patient data to screen accounts for bankruptcy, Medicaid and charity eligibility, patient expiration, and more, to remove the accounts that shouldn’t go to collections. Then it segments the data based on priority and treatment strategies and transfers those segments to the appropriate in-house collections department or agency. The software also continuously monitors accounts for changes in patients’ ability to pay, which is no small feature. According to the aforementioned survey of hospital executives, almost one-fifth of hospitals do not re-check patient eligibility for insurance. And even worse, one-fifth of hospitals lack any process or a third-party partner to recover bad debt. This one function alone could significantly improve hospitals’ collections efforts. Martin Health System accomplished its goal of better agency monitoring through an overview of collections progress that informed business decisions. Throughout its evaluation process, the Collections Optimization Manager provides performance reports in a real-time dashboard. And the service comes with support from revenue cycle consultants who review the data. They advised Martin Health on optimal collection strategies and suggested opportunities for improvement. Ultimately, Martin Health System enhanced its collection efforts while reducing the cost to collect. The healthcare organization also found new areas to increase collections performance. In just eight months, the healthcare organization transformed its collections performance. Having a better handle on its self-pay receivables boosted Martin Health’s overall receivables by more than $4 million in just six months. That included increasing collections by $3.1 million, and finding $975,000 in Medicaid coverage. It accomplished all of these goals by putting the right healthcare debt collection software in place. Read Martin Health’s success story here or schedule a demo to learn more.
Healthcare providers should be able to focus on what\'s important: their patients and the care they need. However, providers and their staff must spend much of their time on administrative tasks. A study by AMA Prior Authorization revealed that providers are spending two business days per week just completing prior authorizations. That doesn\'t even account for other administrative tasks. Meanwhile, providers rely on more payers and plans than ever before, which is often tied to their clinical performance, and patients are becoming increasingly more responsible for the cost of their care. This is leading to an increase in operating losses per physician of 17.5 percent of net revenue in 2017. Providers must prioritize their revenue cycle efficiency if they want to remain financially solvent in the ever-shifting healthcare field. To safeguard its revenue, Schneck Medical Center in Indiana, the only hospital serving four counties, wanted a way to optimize claims follow-up by identifying and targeting the claims needing attention as quickly as possible. This was especially important because an estimated 10 percent of the population lacks insurance and 13 percent lives in poverty in the primary county the medical center serves. Schneck\'s goals were to: Ensure denials did not exceed 3 percent of net patient revenue. Achieve the estimated total net preventable denials of $3.2 million or a 2 percent increase to operating margin. Reduce denials by confirming patient insurance eligibility, verifying medical necessity, and obtaining prior authorization when appropriate. Makenzie Smith, director of patient financial services at Schneck, said that industry pressures to reduce healthcare expenses and provide a better patient experience are what drove the healthcare organization to look at the revenue cycle technologies and processes it had in place. A better denials management system The denial management process can be cumbersome, especially for community hospitals like Schneck. It takes up too many resources and far too much time. Schneck was looking for better denial analysis reporting and automation software so it could more effectively manage denials and significantly increase collections. The organization\'s search led to Experian Health\'s automated approach to tracking the root causes of denials and identifying the trends in order to improve procedures. The software tool provided a comprehensive solution and allowed Schneck to optimize its claims workflow with remittance detail and analytics. It now helps the medical center identify denials, holds, suspends, and zero pays and uses electronic remittance advice and claim status transactions to identify appeals won or lost with payers. This allows Schneck to identify and target the claims that require immediate attention. The payoff With executive leadership buy-in and support, Schneck created a new, better process for claims denial management by: Reviewing preventable denials with customized queues in real time. Identifying directors with staff responsible for checking a patient\'s benefits and obtaining prior authorizations. Reviewing all denials over $500 in the revenue cycle department. Establishing a schedule for reviewing denials each month. Schneck\'s new streamlined process and real-time visibility into denials data has allowed staffers to work on denials more efficiently. The ability to link denials to a specific staff member in a specific department has further streamlined the process. The relationship between the front and back office has improved because both sides have achieved a better awareness of processes. With the right denial analysis and automation, healthcare organizations like Schneck can manage denials effectively and increase collections significantly.
There’s no doubt that identity theft is a concern for any industry that handles sensitive customer information; health care is no exception. In 2017 alone, the U.S. Department of Health and Human Services reported 477 healthcare breaches. Together, they compromised nearly 5.6 million patient records. Without adequate IT security, everything that organizations use to improve patient engagement and the continuum of care – especially patient portals – becomes an open door for hackers. But how do we keep patient data secure without burdening patients? We asked Victoria Dames, Experian’s senior director of identity management, how the healthcare industry is evolving to solve for identity theft, as well as best practices all healthcare organizations can adopt to better meet this growing threat. In the world of healthcare, both patients and providers are understandably hyper-sensitive about the exchange and security of healthcare data. How is the industry arming itself to protect data? Are there any shifts you’ve witnessed in security practices over the past few years? Absolutely! The industry has quickly evolved into leveraging technology to share data between organizations and with their patients, but this does bring inherit risk. Criminals also took notice to this shift, and medical identity theft became one of the fastest growing types of identity theft with a roughly 22 percent annual growth. With this evolution, the industry has tightened up on data access, especially as it pertains to the patient. Over the last five years, we’ve seen the shift to enable technology to help identity-proof patients before granting them access to sensitive information. This used to be a manual process. What are some of the best practices healthcare organizations can adopt to limit instances of medical identity theft? First, organizations must understand where their access points are throughout their ecosystems. With 64 percent of patients citing a privacy issue as a key concern for accessing health information online, they should inform patients that they’re providing secure methods for access to their information. Additionally, healthcare organizations must evaluate how physicians access different types of data and portals. As healthcare caught up to electronic records and systems, portals for e-prescribing also arrived. Given the nature of this use case, providing a heightened NIST level of identity proofing is required. The key is to assess what level of identity proofing is needed at each entry point to keep balance on security and the end-user experience. When you look to the future of healthcare, what types of digital technologies and solutions do you see providers putting in place to prevent fraud and protect patient data? Technology moves quickly and so do we. Identity proofing has seen an acceleration in the use of biometrics at different points of entry throughout healthcare organizations, which strengthens our solution. We are starting to see the use of biometrics, similar to your phone face ID, used more broadly through healthcare in conjunction with existing identity-proofing solutions. Experian achieved the Kantara Initiative certification with adherence to the latest guidelines achieving NIST 800-63-3 IAL2 (National Institute of Standards and Technology Special Publication Digital Identity Guidelines 800-63-3 for Identity Assurance Level 2 (IAL2)). This reinforces our commitment to support clients in authenticating consumers, while balancing a positive experience. Learn more about Experian’s identity management solutions.
An estimated 82 percent of hospitals receiving Medicare and Medicaid payments in fiscal year 2019 are expected to have their payments reduced because their readmission rates are too high. The Centers for Medicare and Medicaid Services implemented the Hospital Readmissions Reduction Program to reduce the number of patients being readmitted to hospitals less than 30 days after leaving. This program’s goal is to improve patient care. While a number of factors influence hospital readmission rates, they often occur when patients are not communicating issues with their doctors or when more communication is needed between patient care teams. For example, when the attending physician in the Emergency Room (ER) doesn’t have the necessary background on a patient’s condition, a patient is more likely to be readmitted. This can lead to longer waits to get proper treatment. To best serve patients by reducing hospital readmissions, healthcare organizations need to improve patient care coordination. Technology enhances communication among inpatient, outpatient, and long-term care teams, and it gives patients more of a stake in their own care. Coordinating patient care USMD WellMed Health System set a goal to significantly decrease its readmission rates, so it needed a way to alert physicians if their patients showed up in the emergency room, particularly within 30 days of leaving the hospital. The organization implemented Experian Health’s Care Coordination Manager and MemberMatch® solutions. Care Coordination Manager provides a messaging platform for patients’ post-discharge care plans, which is a secure place for patients and providers to communicate. It helps hospitals and health systems provide solutions for 30-day and 90-day management of health episodes. In one case, a doctor was able to intervene when a patient with chronic obstructive pulmonary disease showed up in the ER. The doctor was notified, spoke to the ER physician, and developed a course of action that allowed the patient to go home without being admitted to the hospital. In addition to avoiding hospital readmission penalties, USMD WellMed provided better care with the service and made the patient happier as well. While healthcare professionals agree there is a growing need to help patients become more engaged in their care, many are uncertain about the tools and opportunities to make it happen. Care Coordination Manager introduces an easy way for patients themselves to communicate with their providers and get clarifications on follow-up care. USMD WellMed also implemented MemberMatch, which lets Accountable Care Organizations (ACO), ESRD Seamless Care Organizations (ESCO), and health plans better manage members’ clinical episodes by alerting care managers when a patient is admitted, discharged or shows up in the ER. Doctors appreciate notifications Despite the numerous benefits of reducing hospital readmissions, there was one major reservation when the phone alerts were implemented. While USMD’s physicians wanted to be more attuned to their patients’ needs, they were worried that they would be inundated with text notifications. The program was initially limited to high-risk patients. But once physicians started getting the alerts, they immediately realized the benefits . Some doctors even asked to expand the platform to all of their patients. Ultimately, this tool improved both USMD WellMed’s provider and patient satisfaction. USMD WellMed was able to reach its goal of significantly reducing readmission rates in a short period of time, according to Dr. Bryan Demarie Sr., Market Medical Director of USMD WellMed. The Care Coordination Manager helps physicians and patients take a more proactive approach to treatment by handling problems before they escalate to another stay in the hospital. Opening the lines of communication allowed the healthcare organization to meet its readmission goals, improve patient care and save USMD WellMed from costly penalties. Support the sharing of post-acute patient care information to help providers succeed in the new era of value-based reimbursement. Learn more.
People increasingly expect immediate access to information at their fingertips. They want online access for everything from food delivery to healthcare. But as healthcare organizations enroll more patients through online access, how do they protect themselves from data breaches without impeding patient engagement? Data breaches are more prevalent and costlier than ever. Up 6.4 percent in 2018 compared to 2017, the global costs of data breaches reached $3.86 million last year. The healthcare industry has been particularly hard-hit. Over 90 percent of organizations have experienced a data breach since 2016, and more than 180 million records have been stolen since 2015. Just last year, a Missouri-based healthcare organization discovered that its patient portal was vulnerable for more than a month after hackers installed malware. In that time, almost 6,000 patients’ debit and credit card numbers could have been compromised. This incident alone demonstrates that improving cybersecurity in healthcare is vitally important. This is why one of New York\'s largest medical groups, AdvantageCare Physicians, made it a priority to strengthen the security of its Epic MyChart by adding a multilayer identity verification step at the time of patient enrollment and throughout every portal access request thereafter. Patient identity verification secures patient portals More than just satisfying the need for constant connectivity, patient portals are exceptionally helpful. They allow patients to access test results, view their medical record, schedule appointments online, and communicate with their providers from their mobile devices. Despite online platforms being a target for hackers, AdvantageCare Physicians executives know that patient portals help patients engage in their healthcare and empower them to take control of their health. So the organization turned to the same technology that is trusted by banks, retailers, and government agencies to protect this valuable tool. Identity-proofing technology can quickly authenticate patients when they access an online portal by evaluating the identity, device, and risk factors of a given user. This multilayered check happens in a second so patients aren’t left waiting on a load screen. Through continuous protection that ensures complete security without sacrificing ease of use, patients\' trust grows because they know their electronic medical records are safe. This patient trust can go a long way. A Software Advice study found that due to concerns about data breaches, 21 percent of patients keep information from their doctors. Securing its patient healthcare portal with Experian Health’s Precise ID helps AdvantageCare Physicians open up communication to provide better care. This, in addition to improving access to resources, supports the organization’s goals of improving health management and promoting wellness. These additional verification steps also protect AdvantageCare Physicians from compliance risks. For example, the Centers of Medicare and Medicaid Services’ Promoting Interoperability standards set out requirements for collecting and maintaining electronic medical information to ensure healthcare cybersecurity. Experian’s Precise ID complies with this and many other programs. Decreased need for IT support Given the many advantages of a fully protected patient portal, AdvantageCare Physicians\' final concern was the effect of increased self-service traffic. More users accessing the portal more regularly might create bottlenecks. But patient identity proofing actually increases the platform’s user bandwidth. For example, Precise ID streamlines the process for patients signing up. Traditionally, AdvantageCare Physicians\' IT department would have to validate each new patient identity on the back end, but Precise ID can quickly authenticate these users. This has reduced the need for IT support by 80 percent. IT also spends less time correcting records because letting patients create their own accounts increases accuracy while reducing the number of duplicates. Online self-service platforms for healthcare organizations like AdvantageCare Physicians enhance patient care. But just like any other online transaction, patients need to know that any information they provide through the portal is secure. Sufficient cybersecurity for its healthcare portal lets AdvantageCare Physicians focus on delivering the personalized resources patients need without the worry of a data breach. Learn more about how to reduce risks during patient enrollment.
About 8 percent of the costs involved in U.S. healthcare are spent on administrative costs. Whether it’s paperwork for a simple follow-up or processing billing for a complex surgical procedure, the costs add up immensely for healthcare organizations. It\'s a problem that Boys Town National Research Hospital knew well, according to Toni Gross, Director of Patient Financial Services. A few years ago, Boys Town Hospital staff realized they had a front-office team that was doing a lot of manual work, which was causing claims denials. The back-office team was largely focused on fixing the denials, but not communicating with the front-office staff about the common mistakes being made to avoid the denials in the first place. “The approach just wasn\'t efficient,” said Gross. “We were on a vicious cycle. Lots of denials, repeating work, repeating work, so I just stopped and finally looked at the process.” Of all the claims healthcare providers submit, 5 to 10 percent are denied, costing providers billions in the process each year. And above all, it puts pressure on a team that could be handling other tasks. It’s one of the many reasons providers like Boys Town Hospital need to overhaul their revenue cycle management metrics. Boys Town Hospital wanted to connect the front-office and back-office teams so they could focus on what really mattered: Decreasing denials and getting paid as quickly as possible. The importance of automated software But how can busy providers fulfill their mission when they’re faced with these revenue cycle management challenges? Boys Town Hospital needed an automated solution to get their organization on track. Because the front-office team had been separated from the rest of the process, they were not getting any feedback on their work. They were spending all of their time checking eligibility, and handling scheduling and registering. To reduce denials, the front-office needed a way to financially clear accounts upfront. They also needed an intelligent work queue to identify and present only those patients who need follow up by staff in order to be cleared prior to arrival, minimizing the hands-on work that bogs down operations. Boys Town Hospital decided to implement technology that could automate up to 80 percent of their pre-registration activities. While the back-office team took the lead in implementing the technology, both teams started working together to make sure they were aligned in how to reduce claims denials. In 2017, only a year after going live, Boys Town Hospital saw a 20 percent reduction in eligibility denials and eliminated all of their manual work. “The key to success was thinking about the entire revenue cycle,” Gross said. “Experian Health\'s many tools fit together to make the process seamless. Also, it\'s important to get things right from the beginning.” The team built as many edits as possible to avoid problems. When new problems come along, more edits can be inserted to avoid them moving forward. \"I call it backing up the bus,\" said Gross. \"There\'s a problem; you\'re presented with it; back up the bus. Where did it start? How can I avoid it?\" Automating the processes mean that staff only touch the claims that that will cause problems on the back end. This increases staff focus because they are not handling the same tasks repeatedly. Work smarter, not harder Healthcare revenue cycle management is a challenge — but implementing automated software can be a game changer. \"I am a support to physicians. I am a support to nurses. I want my phone to ring when they have a question about anything,\" said Gross \"It\'s my part to step over into their world, listen to them, and figure out what it is that I can do to try to make that a little bit better for them. That\'s how I make the patient experience better.\"
