Category: Cost Reduction & Process Improvement

How West Tennessee Leverages MedeAnalytics to Gain Big Picture Insight into Its Revenue Cycle

In MedeAnalytics’ recent webinar, “Get Big Picture Insight into Your Revenue Cycle,” we demonstrated our Business Office solution and featured insights from Wade Wright, Executive Director of Patient Financial Services for West Tennessee Healthcare. The organization is a public, not-for-profit, four-hospital health system based in Jackson, Tennessee that covers 17 county service areas. It has a 635 bed hospital, outpatient clinics, 3 medical centers, 20 primary clinics, and 70 physicians and non-physician providers.

During the presentation, Wade shared how his organization uses data analytics to optimize cash flow and improve collections by bringing complex patient accounting data into a unified view.  Wade and his team are able to:

  • Prioritize accounts and increase cash
  • Understand the root causes of denials and bad debt
  • Identify self-pay patients’ propensity to pay and reduce the cost to collect
  • Leverage self-service analytics to gather meaningful insight

Put simply, data is better than “going by your gut.” Until you really work with data, and understand what is going on, it is difficult to gain insight into trends.

Some of West Tennessee’s specific results and benefits include:

  • At Jackson-Madison County General Hospital, billed account receivable dropped $34.9 million for a reduction of 15.2% in four months
  • Bad debt to charity ratio dropped from a high of 3:1 to 1:1 and has remained consistent since February 2016
  • West Tennessee improved business office efficiency while proactively reducing denials and bad debt, which ultimately helped them achieve a centralized financial clearing center and meaningful, self-service data analysis

To get the full details on West Tennessee Healthcare’s journey to revenue cycle success, download the webinar here.  You can also check out our revenue cycle best practices blogs here.

Tips & Tricks to Identify Bottlenecks & Manage Reimbursement in Your Business Office

The healthcare financial landscape is constantly in a state of flux— with ICD-10, fee-for-value reimbursement, and shared accountability payment models contributing to the significant change – but one thing remains the same: uncompensated care is at an all-time high. To help providers navigate their financial health, MedeAnalytics Business Office provides insight into revenue and cost savings opportunities, by bringing complex patient accounting data into a unified view.

Comprised of several financial management tools our Revenue Cycle and Business Office solutions offer data analysis on accounts receivable, denials, bad debt, and payer contracts.  Here are the top three tips and tricks you might consider when using the solution:

#1: Think Payer Management, not Payer Monitoring

Mitigate wasted staff time due to delay tactics and confusing information from payers. Intelligent insights allow you to manage and compare behavior on a payer-by-payer basis in order to optimize team efficiency.

#2: Shift Your Focus from Denial Appeals to Denial Prevention

Denial rates have increased in the past two years and appeal success rates for most organizations are falling short. You can get ahead of this by reallocating appeal resources towards prevention and focusing on avoidable errors based on historical results and trends.

#3: Smarter, not Harder, Self-Pay Collections

Due to the larger number of high-deductible ACA plans, the patient is now becoming one of, if not the largest payer.  Streamline self-pay collections efforts by using predictive models to compute a patient’s propensity to pay.

Not using Business Office, but curious to learn more? Check out the Business Office solution page to read about the benefits. 

Measuring Quality in Patient Access

For years, relatively little attention was paid to patient access. However, with today’s consumer-driven healthcare environment, where the focus on patient satisfaction has become a competitive advantage, ensuring positive outcomes in the patient access department is critical.

The Advisory Board released a survey recently highlighting hospital executives desire to meet consumer expectations and improve patient engagement. In order to develop a successful patient-centric strategy, healthcare organizations need to define and address the challenges in achieving high quality patient access.

Defining a Positive Patient-Provider Interaction

A well-constructed patient access experience can be defined as one where both the provider and patient understand and agree upon the financial implications of the services expected. Data from multiple sources, both current and historical, should be considered to support the financial clearance process. The most common sources of data include eligibility and coverage information from payers, Medicaid agencies, credit agencies, patient accounting systems and managed care contracts. Once the data from all of these sources have been considered, and the patient is financially cleared, the focus can be exclusively put on the care of the patient. 

This may sound like a straight-forward concept but anyone involved in the healthcare revenue cycle knows that this process is anything but “straight-forward.” Many points of failure can occur along the way including not obtaining a proper authorization, not screening for a particular coverage option, or inaccurately informing the patient of their out-of-pocket obligation. These failures often lead to problems down the road for billing and collection and can negatively impact patient satisfaction. 

Challenges to Achieving Enhanced Patient Satisfaction and Outcomes

There are many challenges to standardization and the improvement of quality outcomes in the patient access arena. Multi-hospital providers often have several patient access systems that are not integrated across the patient access continuum, which disrupts patient registration workflow. Measuring the overall patient access quality in a particular intake area or at the department level is simply not possible across disparate systems. 

To that end, if management of the patient registration/financial clearance process cannot be standardized then the question of, “how many of our patients were financially cleared yesterday?” cannot possibly be answered.  Patients are pushed through the admissions process without enough financial clearance which leads to financial uncertainty for both provider and patient. Couple that with the potential stress of their medical condition, the patient’s clinical outcomes may be compromised, which in turn impacts provider revenue under a value-based reimbursement system.   

For many of the leading healthcare delivery systems, getting patient access right is a high priority. The next phase will be focused on efforts to standardize and improve processes across the enterprise. In order for an organization to be efficient, technology needs to “bridge the gap” between patients and consumers across the enterprise while also providing customization and flexibility. It will be interesting to see how providers meet this challenge and how the patient-provider relationship continues to transform as more healthcare leaders adopt consumer-focused strategies to drive access and engagement.