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Tennessee health system seeks revenue cycle improvement

West Tennessee Healthcare, serving the greater Jackson region, first contracted with business intelligence vendor MedeAnalytics in 2007 to assess the status of its revenue cycle and self-pay programs. Over four years, the organization analyzed 4,000 record reviews, found $3.7 million in refunds owed, and won $900,000 in payment appeals.

The four–hospital delivery system used the vendor’s platform most recently in January 2016, when it embarked on a major revenue cycle initiative to analyze patient access and denials management issues.

Back in 2007, analytics was conducted by a small number of revenue cycle management staff who loaded back-end data to find insights into what already occurred. The project begun in 2016 and moving into 2017 is considerably larger and supports upgrades to its revenue cycle and electronic health records systems, says Bart Teague, executive director of patient financial services. And, this new projects will use real-time data to find out what is happening now.

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In particular, West Tennessee will use analytics to improve revenue cycle workflows and develop a more centralized process as patients move through the system.

“We’ll use analytics to create standard workflows and to identify trends early to correct problems or avoid them,” Teague explains. “Our goal is to determine root causes of payment denials. Is there something in the contract that causes denials or a system issue where data is not flowing correctly?”

The revenue cycle workflow will start when a patient is scheduled with a work list that covers verification of insurance coverage and benefits, payer authorization, estimated patient payment responsibility, as well as follow-up communications with patients on how they will make payments.

Analytics also will assess the process of creating HIPAA transactions, such as whether all fields consistently are being filled for the claims and electronic remittance advice transactions. The goal is to reduce revenue leakage, particularly bad debt and denials, Teague adds.

This includes a goal to improve point of service collections that started a couple months ago; it’s still a little too early to say if significant improvements have been achieved, he says.

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