ThedaCare, a community health system consisting of seven hospitals, numerous clinics and related services in the Midwest, was looking for a partner to assist them in transforming to a Patient Centered Revenue Cycle of Excellence.
When they approached HBS, we knew the challenge was in our wheel-house for revenue cycle consulting and business operation improvement. This multi-phased process began with a Revenue Cycle Assessment focused on identifying opportunities across people, processes and technology throughout the revenue cycle.
ThedaCare Specific: Growth, including acquisitions resulted in multiple business offices. System wide revenue cycle communication and standard processes were maligned, providing opportunity for improvement. Traditional revenue cycle processes were not allowing for optimized upfront collections or a first class patient financial experience.
Industry Wide: Payment models are evolving from volume to value-based and there is overall complexity within revenue cycle processes as relates to generating a clean claim and receiving accurate payment. Flexible, consumer friendly financial options are the wave of the future.
After gathering qualitative and quantitative data, AHS created a system wide oversight structure to drive bi-directional communication, education and awareness across all business units with specific sub-committees focused on key revenue cycle areas (Access, Revenue Integrity, Operations and Payer Relations) and opportunities focused on optimizing people, process and technology.
Hire a full-time VP of Revenue Management and prioritize opportunities for improvement through the Value Stream process.
Adopt HFMA Map® metrics and use a single source of truth for meaningful measurement.
Create cross-functional teams of subject matter experts to align with top payers.
Long Term:3 year plan to become a “Patient-centered Revenue Cycle of Excellence” and to reduce $8 million through optimization of process and technology.
Identification of $300,000 in annual uncollected revenue due to a billing change.
Recommended implementation of transitional care management for an approximate opportunity of $600,000 annually.
A “patient-centered” revenue cycle of excellence
Identification of revenue leaks and assurance that all billable services are captured
Leverage meaningful data to inform payer discussions during contracting
Focus on long-term cost-savings, while improving efficiency and maximizing productivity
Reduce claim denials and move from denial management to denial avoidance
Development of sustainable strategy to manage daily coding volume to ensure timely billing and health A/R
Identify and adoption of metrics that provide overall health assessment of revenue cycle functionality
Revenue Cycle Assessment and Executive Summary with short, medium and long range improvement and cost saving opportunities identified
Denial Sourcing Summary, which provided insight into preventable denials and their root causes