Reducing revenue cycle handoffs pays dividends for a Phoenix hospital.
Jess Martinez had had about enough of edits. Not edits of the journalistic variety, but the kind that hold up payment of millions of dollars in claims for his employer, Phoenix Children's Hospital.
"Something that with the right system could be resolved in a day was taking maybe three to four days," says Martinez, the 345-licensed-bed hospital's director of patient financial services. "It wasn't uncommon to see up to $9 million in bills that were held up for several days due to edits that needed to be made."
Thanks to a retooling of the revenue cycle staff workflows, such edits are now being done simultaneously rather than being worked on piecemeal by individuals.
Now, instead of being passed along a chain of individuals to clean up certain components of the bill, "they're being cleaned up real time," says Martinez. "It's no longer OK to have $9 million waiting to be billed for three days because of edits that need to be made."
Martinez worked with Ken Kilmer, the patient financial services software system administrator, to bring in Eclipsys software that allows multiple people to work on claims and bills at the same time. But the reengineering process required much more than getting the right tools in place—it involved the building of a team of individuals working toward the goal of getting money the hospital is owed in the door faster.
Martinez brought a new FTE on board to train up to 60 registrars to collect valuable preadmission information before the patient is admitted. Phoenix Children's now has 10 FTEs doing that work. "They know now this is a fundamental part of their job," Kilmer adds.
To facilitate teamwork and a sense of common purpose, Martinez started publishing a daily cash goal for the staff. Further, Martinez is focusing on denied claims, with some success.
"Denied claims have declined to about half of what they were at the same time last year," he says, in part because staff can now identify patterns that cause payers to deny claims, allowing staff the right information to "tell payers they need to stop doing that," he says wryly.
As a result, cash collections have increased, Martinez says, but the most obvious benefit of the new focus is reflected in days in accounts receivable.
"When I got here [in 2007] we were at 67 or 68 days in gross AR, and last month we closed at 52.6. A lot of people would kill for that."