How to Make Millions in Hospital Revenue Reappear

Allen, who had worked in the emergency department earlier in his career, knew that the solution they needed had to account for the speed at which clinicians work in those departments. “Whatever we deployed had to be simplistic and couldn’t consume a lot of time. We needed something with a lot of intellectual knowledge, but with check marks for the staff,” he explained.  After attending a conference, Allen narrowed his search to two products one by San Francisco-based McKesson and the other by Picis, from Wakefield, MA.

Allen brought both systems back and tested each with the ED staff. After hearing their feedback, they settled on Picis LYNX, taking the system live in October 2008.

“A year later, after we’d tracked all the results, we found we weren’t losing $10 million [in the ED], we were leaking $29 million. We were absolutely floored,” says Allen.

Their ability to consistently bill payers not only was gleaning greater revenue, but also was helping them document their files to defend against payers refusing to pay. “Some of our payers noticed right away that they were paying us more money than in the past and they wanted the documentation. The fact that we were able to send them the documentation they needed right away and that it was now so consistent helped us, It also has helped us go through three to four audits from other companies,” adds Allen. “Now we know we’re in compliance.”

For other hospitals thinking of launching this type of project, Allen offers this advice, “You need to coordinate this with your whole revenue cycle from admitting to the business office—you must be willing to change processes and you must have support from senior leadership. With any change there’s a lot of pain, so this buy-in is really important.”

The moral of the story: Consistency pays dividends (and no trip to a jungle temple required).