3. Get Serious About Using Analytics Tools
To enhance its ability to find revenue leakage, VHC is going live with a new analytics system in April that will help it identify particular physicians or units that create higher-than-average denials. "We will be tracking denials so we can understand where they are coming from and fix [them] on the front end," Norman says.
Even without the new technology, Norman says she can identify some areas where leakage is a concern, but also adds that the need to provide quality patient care and keep physicians happy complicates efforts to tighten the reins.
"Radiology is one area where we have some leakage," she says. "There is a tug between service and accessibility and getting insurance verification. Physicians want to take care of patients, but if a test like an MRI needs an insurance pre-certification, you have that tug of having to call first, while the patient is waiting and the doc is unhappy."
"We have to think about where we set that line. If I'm the worried person sitting there as the patient, I care about how long I have to wait. The whole challenge is we want to do the right thing and treat the patient right away, but we also have to make sure we get paid for it," Norman says.