A Front-End Preventive Approach to the Revenue Cycle Contributes to a Positive Patient Financial Experience

Two years ago, when I arrived in Northwest Missouri, I was amazed with the kindness and dedication of the caregivers and frontline employees at Mosaic Life Care. Their desire to provide quality healthcare at the best possible value was evident as I walked the hospital corridor and gazed upon the numerous awards for quality and safety. The Malcolm Baldrige National Quality Award, Truven Health Analytics 100 Top Hospitals^®, “A” rating by The Leapfrog Group, Health Strong Hospital by IVantage^® Health Analytics distinction and “Most Wired” hospital by Hospitals & Health Networks magazine, were just a few recognitions. Recently, Mosaic Life Care was also named Health grades America’s 50 Best Hospitals™ for 2018.

I have to admit, I was a little intimidated by the precedent and knew immediately my task as the new vice president of revenue cycle was to create a best-in-class revenue cycle that matched the same level of quality, and fast. After all, the revenue cycle is the first and last point of contact with the patient. That great quality of care, has potential to get lost if, our patients have a bad experience prior to or even after service. That’s exactly why my focus had to be on the patient financial experience.

I’m certain you have all heard the phrase, “garbage in, garbage out.” For decades, lack of integrity in data has plagued the business of healthcare. Trying to control the quality of registration and billing information on the front end has been a constant challenge, which affects billing outcomes and causes unnecessary grief to patients over unresolved balances. In years past, Mosaic had struggled with eligibility, manual calculation of patient liability, lack of consistent prior authorizations, and especially adequate and timely training of patient access representatives. These struggles resulted in significant final write-offs due to access errors, approximately $4.5 million a year about 40 percent of total denials. The consequences of these errors were even more costly when cost-to-collect, increased bad-debt, and patient and employee dissatisfaction are thrown into the mix.

Robust technology is a must in 2018, however, systems that can’t monitor quality, self-assign training, identify presumptive charity, return detailed eligibility, and estimate patient out of pocket costs, are no longer adequate. Newer intelligent applications capable of predictive analytics that are built to learn and adapt are now required. In my quest to automate the aforementioned, we decided that a front-end preventive approach was the best place to start. Following a rigorous selection process, we began integrating AccuReg’s full suite of front-end automation tools into our Cerner Millennium electronic medical record (EMR) system.

We began our implementation with a phased approach. Phase I was focused on basic insurance eligibility, quality assurance, and training. Quality assurance was a critical missing piece for us. Our new technology enabled us to create an edit-based workflow to track, monitor and manage registration quality and point of service collections, including identification of any missed collection opportunities. A common problem for revenue cycle is the span of control over patient access representatives, especially in larger health systems. Typically, revenue cycle will own in-patient and emergency department registration, however, clinic and out-patient centers fall out of scope. Mosaic is no exception as our clinic and out-patient full time employees report through clinic operations, however, revenue cycle owns the process and the front-end technology. This structure, although operationally effective, posed many challenges for training and registration quality and consistency. The new technology created a very effective method for accountability via reporting and dashboards. We have recently included this data in our monthly operating review for each service line. Additionally, registration accuracy is now tied to goals and performance metrics.

Phase II includes patient identification, financial screening, presumptive charity and authorization management. Although we still have two modules to implement, in just eight months we were able to increase our registration quality to 96-98 percent accuracy rate and improving. We have significantly reduced our patient access final write-offs by more than 50 percent which now measures about 1.6 percent, down from 3.8 percent overall. Our bad debt has decreased by about 30 percent, as our charity has increased at a slightly lower rate.

One of the most rewarding aspects of this new technology for Mosaic is the reaction and level of satisfaction of our patient access representatives. They are thrilled with the functionality and ease of use of the technology and feel that they can provide much better service to patients, thus ensuring a positive financial experience.