Becker's ASC Review

48 Executive Brief: Revenue Cycle Technology Sponsored by: W hy do we use iPhones routinely to navigate through traffic but not use them to track patient conditions? We have access to more data on our uploaded photos than we do on our insurance claims. While technological ad- vances seem to have permeated into our day-to-day lives, they seem to enter slowly into our work lives as healthcare profes- sionals. This double-life comes at the cost of our growth as individual organizations and collectively as an industry. It's far easier to implement technology ideas today than it has ever been in the past. However, several medical organi- zations continue to operate with archaic and expensive technology, untrained staff and broken processes. Consider basic processes such as billing claims, posting payments, following up on unpaid claims — are these done any differently than they were five or even 10 years ago? This paper focuses on applying new tech- nology ideas to fundamental processes such as revenue cycle management to ex- tract greater profitability from day-to-day operations of ambulatory surgery centers. Applying Analytics to Rev- enue Cycle Management Which zip codes have the timeliest pa- tient payments? Which insurance plans of BlueCrossBlueShield take the longest time to pay? What would be the down- stream revenue of new patients seen this week? These types of questions are dif- ficult to answer intuitively and by doing simple computations over Excel. These require a dynamic system that automati- cally tracks and analyzes various aspects of the process — from entering charges to posting payments to tracking denials. Applying analytics to revenue cycle man- agement will help centers make informed business decisions. Building a Dashboard The basic premise of using analytics in op- erations is to detect changes before they become obvious. Before reimbursements decline, the insurance mix changes or new patients reduce or basic denials occur. It may take several months before smaller changes add up to tangibly show that profitability has changed. Here are a few sample indicators that must be on ever center's dashboard: • 60+ insurance accounts receivables • Days in AR • Collection percentage • Mix of insurances • Physician contributions • Denials due to front desk • Denials due to billing • New patients vs. existing patient ratio • Contract timelines • Medical supplies cost and utilization • Room utilization • Staff utilization • Case volume and costs • Procedure volume and costs Traditionally, these indicators are com- pared across previous months, quarters, years. The dashboard must allow the administrator to drill deeper into specific indicators. For example, if there is an in- crease in denials due to the front desk in a given month, it could be because of a certain staff member. Exploring further, the administrator may discover that the denial was due to lack of timely authoriza- tion from a particular insurance company. When data is available, comparisons must be made with other centers and state or national averages. When a Dashboard Becomes an MIS The basic dashboard described above can be extended to evolve into a Manage- ment Information System that integrates dynamically with the practice manage- ment and electronic health record system to assist, track and provide timely insights during everyday operations. Let's consid- er a couple of examples on how this may be done. Example 1: Consider an insurance plan X that pays on an average of 21 days after submission and an insurance plan Y that pays on an average of 40 days after sub- mission. When a patient with insurance X arrives, how the revenue cycle behaves has to be substantially different from when a patient with insurance Y arrives. Insur- ance Y is riskier than insurance X — in terms of the time it takes to get paid — and this risk must be built into the billing process. The MIS must know and allocate work accordingly — greater follow-ups must be built in for Y. Similarly, the MIS must know overall payment trends asso- ciated with both insurances X and Y (by say a weighted average grading system) and make decisions using that information (for example, Y may require more follow- up calls vs. X and therefore needs more resources than X does). Example 2: Consider patient data from an EHR. Could patients with higher risk of colon cancer (identified from the EHR) get further follow-up calls for screening colo- noscopies? Can the MIS identify such a patient when she shows up at the door? Can the process be built around such pa- tients — tracking medication compliance, billing and payment trends together? What impact would this have on AR and overall Using Advanced Technology to Simplify Revenue Cycle Management By Satish Malnaik, CEO & Co-Founder of NextServices GUIDE TO A PREDICTIVE REVENUE CYCLE FOR ASCs 1. 2. 3. 1(866) DOC-NEXT | www.nextservices.com/ASC build a basic dashboard to track operations use dashboard to make operational decisions 3 most imp needs of patients, physicians and staff at the ASC 3 key numbers to track daily, weekly and monthly Prioritize list based on High, Medium, Low Build a basic, dynamic dashboard that allows drilldowns Integrate PMS, EHR, external systems (e.g. health exchanges) Create rule-based workflow (e.g. # of AR calls for Mary) Build automations (e.g. generate statements if X occurs) Integrate MIS with internal processes such as HR teach MIS to predict outcomes Build correlations using historical clinical and admin data Identify broad trends (e.g. payments from BCBS in Q3) Use commercial/ custom machine learning algorithms Teach MIS to learn from the past and predict the future MIS (info system) PREDICTIVE REVENUE CYCLE ASC DASHBOARD SERVICES AND SOFTWARE PLATFORM FOR AMBULATORY SURGERY CENTERS BILLING | CONSULTING | EHR

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