From coding to case management, revenue cycle tech projects are full speed ahead all throughout the revenue cycle spectrum.
Technology implementation is not new to revenue cycle, and leaders need to think outside of the traditional revenue cycle box when it comes to new technology.
Revenue cycle isn’t just patient access and billing, it spans across the clinical space too. Saving big in revenue cycle doesn’t just mean shoring up your patient-facing processes, revenue cycle leaders need to be looking in the clinical space too.
Here are three organizations who are placing a focus on middle revenue cycle technology.
Henry Ford Health
To improve efficiency in its coding workflows, resulting in lower costs, reduced backlogs, and enhance patient and provider experiences.
Henry Ford Health expanded its collaboration with CodaMetrix to include patient bedside visits, where abstraction takes an average of 40 minutes per patient and accounts for 20% of the health system's overall coding costs.
AI improves Henry Ford’s bedside medical coding process in several ways. First, it automatically codes the simplest procedures, taking that work off its coders’ plates. By 'simplest,' they mean the procedure notes that match closely or exactly with how the ICD codes themselves are written.
The technology does this by bringing together all the complex information required to identify, understand, and code a bedside professional charge. It then predicts and assigns charges and diagnosis codes, automating cases directly to billing.
The platform also creates a nuanced understanding of the patient journey and can identify potential charge gaps where services were likely provided but there is no documentation. Once identified and routed to coders for follow up with providers, these estimated charge gaps can equal as much as 8% of overall bedside revenue that was previously left unbilled.
By implementing the AI, Henry Ford predicts it will increase workflow efficiency by reducing errors, missed charges, billing backlogs, and claim denials while lowering costs.
Hillcrest HealthCare System
To create a new care model through technology that encompassed five ‘rights:’ The right patient, care, setting, documentation, and billing/payment. Using this approach, patients would be placed at the center of the conversation, with communication and care facilitated by a resource manager following that person throughout their encounter and beyond.
Hillcrest HealthCare System, the Oklahoma market of Ardent Health Services, needed to move away from siloed utilization review, care coordination, and discharge planning functions that sat side-by-side.
Hillcrest is very large in scale, so to set up a model where patients come first and processes are designed to serve them best, it needed the right technology.
Historically, it’s been a challenge for Hillcrest to introduce technology that would enable this process at the level needed. The labor required was always too great, the quantity of data needed was too vast, and consistency and leadership at scale was hard to achieve.
However, in mid-2020, it implemented XSOLIS’ CORTEX® platform to address those challenges and allow clinical staff to refocus their efforts on the patient, not administrative work. With it, the staff has access to a real-time, artificial intelligence-driven view of each patient’s medical necessity, prioritizing cases by revenue sensitivity and risk while also using the platform as a channel to communicate with payers.
In the first two years, Hillcrest’s inpatient-only alerts caught $1.76 million in potential missed inpatient revenue. Along with a 12% reduction in observation rates, this has resulted in an additional $3.28 million in inpatient revenue.
The healthcare system was also able to improve observation-to-inpatient conversion rates from 27% to 52% while reducing inpatient-to-observation downgrade rates to about 4%, a 50% sustained reduction. Inpatient denials were reduced by 102.34% in the first year.
University of Iowa Hospitals and Clinics
To use a “data-driven surgery” program to examine how surgical procedures are conducted, how devices and supplies are used, and where surgical team members are placed. Administrators could then look for more efficient workflow adjustments that might save time or reduce wasteful processes or the use of supplies.
University of Iowa Hospitals and Clinics (UIH) launched its data-driven surgery program in July 2021 in a partnership with Caresyntax, one of several digital health companies developing technology platforms to improve operational and clinical efficiency in different parts of the hospital. The hardware and software program taps into connected devices and platforms throughout the OR while capturing audio and video recordings of the procedure.
Using that data, UIH administrators can gain a better understanding of how surgical procedures are done, as well as how the different members of the surgical team work individually and as a team.
By leveraging EHR data review teams can also take into account clinical outcomes.
The health system has used this technology to make some short-term improvements in OR procedures, mainly affecting efficiency and room turnover rates. UIH says having 5-10 minutes off of a procedure can be an enormous amount of time saved when played out over 50 or more OR rooms.
UIH sees other areas of the hospital where this technology could help, such as the emergency department. The technology could also play a part in credentialling and training programs, especially as healthcare organizations move into value-based care and gain a better understanding of how clinical services affect the revenue cycle.
Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.