Using a Team Approach to Drive Revenue Cycle Improvements (146H)

This session will cover how four hospitals in the University of Rochester Medicine system developed a team approach to improving reimbursement rates by engaging patient access, billing and HIM, revenue integrity, contracting, finance, and operations staff to drive improvements across the full revenue cycle. Facing declining reimbursement rates and increasing denials for medical necessity issues, missing or misdated prior authorizations, registration errors, etc., the four hospitals took a deep-dive into reimbursement data, focusing initially on higher dollar charges/accounts to identify suspect low. This highlighted a number of areas of opportunity to adjust and adopt a number of process improvements specific to billing. These billing changes also required the input of contracting to ensure compliance with payer contracts. At the same time, each hospital developed individual work plans to address issues around medical necessity, prior authorizations, and registration errors that involved both revenue cycle and operations staff. The short-term outcomes of this team approach include approximately $3.5 million in net revenue recovered annually with ongoing analysis for additional opportunity. Perhaps more importantly, the project has helped to break down silos not only between different revenue cycle functional teams but also between affiliate hospitals within the system. One of the long-term results is an ongoing revenue cycle improvement team with representation from each hospital and executive sponsorship from the system.

The session will also discuss how the financial results were accomplished using knowledge and expertise already within the system but working in silos and next steps in the improvement process, including full implementation of contract analysis within the EMR, and the incorporation of machine learning and artificial intelligence to further drive down denials.