Integrate and Automate RCM

Health Management Technology | May 27, 2015

How revenue cycle best practices helped one health system improve its financial performance.

Vice President Product Strategy ZirMed

Even as outcome- and value-based reimbursement models continue to transform healthcare, it’s worth noting how significantly even the best-run health systems and hospitals can boost their financial performance by relentlessly focusing on key revenue cycle best practices, such as automating manual processes.

Stanford Children’s Health (SCH) is the only network in the San Francisco Bay area – and one of the few in the country – dedicated exclusively to pediatrics and obstetrics, with doctors and staff working in multiple specialty facilities, pediatric practices, and partner hospitals across the region.

The organization’s goals were straightforward: reduce or eliminate manual processing, and automate wherever possible. It was also essential that any automated revenue cycle solutions integrate seamlessly with SCH’s Epic system.

“We were looking for ways to take out a lot of the manual processes we’d had in place for decades,” says Andrew Ray, Director of Physician Revenue Operations. “We wanted our staff to be able to focus on things that actually needed human intervention rather than repetitive tasks – yet we were submitting 3,000 paper claims a day.”

One of the issues resulted from SCH outsourcing claims to multiple vendors, leading to higher-than-necessary costs, delayed reimbursement, and the seemingly perennial challenges of claims management in a highly specialized healthcare organization.

Ray advises other organizations to be clear up front about what they’re trying to accomplish and about the issues they face before evaluating revenue cycle technology vendors.

“If you want the right fit for your organization,” says Ray, “you need a partner that can truly shape their solutions around your goals and your challenges – not just general healthcare industry challenges but the particular challenges your health system or hospital faces.

“In our case, we’re a complex organization delivering sophisticated, highly specialized care. Our physicians are innovating how pediatric and obstetric medicine is practiced, which can present challenges when it comes to getting procedures paid by the insurance companies. And the insurance market here in California is particularly complicated.”

Ray says that ZirMed, the revenue cycle vendor SCH selected, “was able to automate our claims management and create customized, highly efficient workflows for our staff, which was a real challenge given the extreme specialization of some of our physicians.”

Workflow was enhanced because SCH made seamless integration with their installed Epic system a requirement in their vendor selection process. “ZirMed’s integration with Epic has made our claims and payment posting teams more efficient,” Ray explains. “Their cloud-based claims management solutions can also accommodate our specialized claims setup and requirements, which dramatically lowers the number of claims we’re forced to create and submit in paper form.”

After claims management and payment posting were brought back in-house and automated, SCH captured significant cost savings and received 20 percent more of their reimbursement within 45 days of the date of service – all while easing the burden on staff through new-found operational efficiencies. “Our teams now accomplish more work with the same headcount, because they no longer spend time on the manual tasks that previously consumed multiple hours of their day,” notes Ray.

With these new revenue cycle solutions in active use, Ray says SCH found it was able to reduce its daily volume of paper claims by 70 percent. “We can put the edits, rules, and fields that we need in place, instead of being forced to resort to paper for highly specialized claims. Because ZirMed’s software automates the processes for these claims even further, we’re gaining additional efficiency on top of what we already achieve by being able to file a greater percentage of our claims electronically.”

SCH has also been able to accelerate reimbursement and reduce the need to rework claims, thanks to the new automated claims management processes and software that catch errors or missing information before the claim is submitted.

“One of our revenue cycle targets is to receive reimbursement within 45 days of the date of service,” Ray says. “Before, the percentage of claims we were able to hit that target for was under 70 percent. Less than a year after implementing ZirMed’s solutions, we’re already close to 90 percent – and we’re continuing to improve that number.

“Once they got over their concern that this might make their roles unnecessary, the staff started to get excited because their jobs became much more interesting – they didn’t have to do those repetitive things as much anymore. They feel much more engaged now, and they really see the impact of what they do on the financial results for the organization.”

About the Author

Doug Fielding is the VP of Product Strategy at ZirMed.

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