Best Practices – System Implementations

WV HFMA

May 16, 2013

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Quick Questions Role in software selection:

Recommend Review what others have found Little to None

Involvement in system implementations: Currently involved in one or more implementations Will be involved within the next 6 months Not involved within the past 12 months

Thinking about the last 2 system implementations you have been involved with, would you characterize them as: Highly successful Successful, but implemented behind schedule Marginally successful, still recovering in some areas

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Getting It Right Implementation – Step 1

Design the project Gap Analysis – Current state vs Future state Metrics – Current metrics vs Future metrics (goals) Fix process first! ROI (CFO’s sweet spot!) Buy-in from RCM group within organization

Select your technology path Full-service solutions – “off the shelf, one size fits all” Bolt-on solutions – “land of smorgasboards” Beta option

Vendor buy-in to your critical success factors up front Remember one important fact – most projects end up

costing way more than the initial proposal

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Getting It Right, continued Project Planning – Step 2

Understand why projects fail!* Technology ROI numbers = mostly fiction ROI rarely drives the investment decision-know what does in

your organization Lack of long-term accountability in technology area Detailed project plans can become the enemy Using the big outside guns only ensures that someone will

get shot

Role of the project team in developing the project plan Oversight of the project plan IT support

*Why Technology Projects Fail: 5 Unspoken Reasons, by Coverlet Meshing, Information Week, April 22, 2013, pp8-10.

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High Performers and IT Support

IT support for revenue cycle

IT collaboration with revenue cycle

0% 20% 40% 60% 80% 100%

55%

51%

79%

71%

High Performers All Others

Level of IT Support or Collaboration“Please describe your organization’s levelof support and collaboration for therevenue cycle 1 = none to 7 = extremely high.(Percentage indicating 6 or 7)”

Source: Strategies for a High-Performance Revenue Cycle, HFMA, 2009, page 20.

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Getting It Right, continued Testing and Training– Step 3

After costs, typically the most underestimated activity – both volume and time

Trust nothing – prove everything Use teams but with management participation Watch out for “we’ve always done it THIS way!”

Test teams must understand future state work flows Redesign workflows testing reveals a better way, not

just because the software would have to be modified to allow you to implement your desired future state

Hardware full load tests Training workbooks and real exercises

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Getting It Right, continued Go Live – Step 4

Identify in advance how you will know when “things” fail Balancing Metric variations outside the normal range

Manage by walking around-everywhere Watch for backlogs

Put the patient experience first Keep your boss in the loop-sooner, rather than

later!

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Getting It Right, continued Post Go-Live – Step 5

Monitor critical success factors and metrics Track requests for fixes and timeframes involved

and hold vendor and staff accountable for timely resolutions

Communicate, communicate, communicate!

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Revenue Cycle Technology If you have a process issue, there is probably

a technology solution out there! Solutions evolving at an amazing pace Ask the question: is there a way to automate

“X” so that my team can work smarter, not harder!

QA programs are designed to check accuracy rates to:◦ Reduce denials◦ Ensure compliance with government regulations◦ Identify patterns of poor work◦ Identify training needs

Manual vs. automated◦ Automated examples include:

DaVincian AHIQA AccuReg CPSI Emdeon Denial Management Compass and Epic McKesson

◦ Majority still manual and daily

Appendix A – QA Programs

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Scheduling technology◦ Access options:

Physician practice based Centralized scheduling operating using call center based technology Patient internet access based

◦ Core functionality: Ancillary and OR; electronic order capture; fully customizable to support resource scheduling, automated rules and patient information; electronic communication with departments and patients

◦ Links into electronic medical record◦ Links into clinical systems◦ Supporting applications:

Medical necessity screening and ABN tools with electronic signature feature

Robot calling for patient reminder calling Workflow rules-based application to move accounts through the

scheduling and registration work flows

Appendix B - Revenue Cycle IT Components

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ADT – Preregistration, registration, census management◦ Call center technology for pre-registration processing◦ Patient kiosks for self service arrival processing, including electronic

signatures, payment processing and receipting, positive patient identification ◦ Real-time automated registration data QA◦ Additional applications:

Electronic insurance verification Electronic transactions for managed care processing Patient charge and liability calculator Electronic patient folders Integrated scanning Payment receipting and treasury processing Electronic address validation Electronic credit scoring and/or electronic account segmentation tool Electronic charity application processing Electronic referral for Medicaid eligibility processing Patient portal for electronic communication r.e. directions, instructions, billing

inquiries and payments Patient satisfaction survey capabilities linked to call center contacts, kiosk utilization,

etc.12

Appendix B - Revenue Cycle IT Components

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Electronic medical record (EMR or EHR) Real time charge capture and service documentation from clinical

systems into core revenue cycle system Workflow technology to monitor managed care requirements, case

management tools Prebill claim scrubber application Workflow technology to manage DNFB workflows; automated coding

validation Billing and collections system application:

◦ Electronic claims scrubber for 837I and 837P◦ Tools to capture all charges within the ACO framework, appropriately bill and

distribute payments◦ Clearinghouse connectivity for claims processing to individual payers – 837I and

837P◦ Calculation of contractual adjustments and patient discounts at time of final

billing◦ Workflow technology to monitor clean claim payment cycles and follow-up

processing requirements◦ Automated follow-up processing using electronic processing and call-center

technology◦ Electronic payment receipt and posting◦ Real time payment validation vs payer contract terms

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Appendix B - Revenue Cycle IT Components

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Billing and collections system, continued◦ Electronic payer logs and data warehousing of claims data with

reporting capabilities needed to model payer contracts◦ Electronic modeling tools for ACO analysis◦ Automated bad debt processing to and from collection agencies

Electronic tracking of KPI’s and other dashboard data for performance reporting within the organization on daily, weekly, monthly and annual basis

Intranet-based staff training application◦ Applications training◦ Workflow procedures◦ Policies and procedures◦ New regulatory requirements◦ Customer service …

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Appendix B - Revenue Cycle IT Components

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Contact InformationSandra J Wolfskill, FHFMAWolfskill & Associates, Inc13430 Bass Lake RoadChardon, OH 4402440 285 4094swolfskill@cs.com