Many back-end revenue cycle processes, from claims submission to denial management, are still largely manual, time-intensive and prone to human error. However, automation can help providers realize efficiencies, reduce labor-intensive work and improve cash flow.
Recognizing the power of automation and revenue cycle efficiency, Mount Sinai Health System in New York City, set out to transform processes at its central billing office with the help of revenue cycle management solutions provider Waystar.
In a Dec. 15 webinar, sponsored by Waystar and hosted by Becker's Hospital Review, two Mount Sinai leaders discussed how the eight-hospital system was able to reduce accounts receivable days, enhance payment reconciliation and increase efficiencies through intelligent automation of several back-end revenue cycle processes and selecting the right clearinghouse partner.
The speakers were:
- Edward Peterson, senior director of IT professional billing and ambulatory patient access, Mount Sinai Health System
- Nestor Diaz, director of revenue cycle, Mount Sinai Doctors Faculty Practice
Here are five takeaways from the webinar:
1. Understand the organization's goals for a clearinghouse partner, revenue cycle solution. When optimizing any part of the revenue cycle, it is important to understand your organization's goals, criteria and vision for the project, Mr. Peterson explained. For example, Mount Sinai made a checklist of criteria its clearinghouse partner needed to have, including the ability to implement customizable work queues, automate remits, submit medical notes electronically and get payer notifications, among other items.
"This checklist was so important to us," Mr. Peterson said.
2. Utilize custom exception-based work queues to improve claim backlog. One of the solutions that improved the efficiency at Mount Sinai's central billing office was the implementation of custom exception-based work queues, Mr. Peterson said. Many claims require employee intervention at one point in their lifecycle. However, having an integrated exception-based work queue that can help employees know what claims need their attention and when can improve workflow. One specific work queue set up by Mount Sinai helps employees know when it's time to recheck a claim based on the typical amount of time a payer takes to adjudicate, Mr. Peterson said.
"We set these up to effectively work or not work the activity … With this particular work queue, we know one of our skilled workers don't have to call," Mr. Peterson said.
3. Analytics provide actionable insights into back-end operations. Having a solution that includes analytics to track and provide insights into denial, remit and payer trends can help providers identify areas for improvement and where staff should be redeployed, the panelists explained.
"You've got to get that data, got to drive those numbers as leadership is always looking at [them] ... It also helps operations make decisions on where they want to deploy the troops," Mr. Diaz said. "We went from a very fragmented, poor visibility environment because of the multiple billing platforms into one holistic database with dynamic reporting where you can create reports on the fly."
4. There are many benefits to automating central billing office functions. Through deploying a revenue cycle solution in partnership with Waystar, Mount Sinai's central billing office saw average days to payment or rejection fall from 36 to 22 days. The billing office also was able to repurpose five full-time employees, automate eight back office processes and gain more insight into its central billing office with comprehensive analytics.
5. Get key stakeholders on board, including leadership. Getting key stakeholders involved in selecting a revenue cycle partner and implementing an automation solution is key.It is important to bring the subject matter experts to the table, including payment processing and A/R employees, to facilitate the implementation process, Mr. Peterson explained. It is also important to have someone in leadership who shares the billing department's vision and can help move the project forward, Mr. Diaz added.
"You really need a leader from the top that shares your vision and understands your pain points, and they need to provide that support and be a game changer across the organization," Mr. Diaz said.
Overall, Mount Sinai's central billing office was able to cut manual touches, increase employee productivity and maximize accuracy through automation and selecting the right clearinghouse solution.
To learn more about the transformation of Mount Sinai's central billing office and what the system plans for the future, listen to the full webinar here.