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Enhancing the Revenue Cycle through EHR and Operational Improvements

LEADING U.S. HEALTH SYSTEM

TRANSFORMS REVENUE CYCLE OPERATIONS

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SUMMARYAccenture helped a large healthcare organization update processes and technology. They improved annual cash collections by $49M and reduced unbilled backlogs by more than 50% within months of beginning the engagement.

CLIENT PROFILEThis large health system’s network of hospitals, outpatient and physician practices treat approximately one million patients a year. Ten years ago, the health network successfully undertook a major IT initiative to replace its electronic health record (EHR) system and improve patient outcomes, customer satisfaction and financial performance. In the years following the implementation, new functionality was released and recommended practices for EHR systems emerged. However, the network’s systems did not always keep pace. This made it difficult to manage patient accounts, especially because hospital revenue cycle processes had increased in complexity. Leadership recognized the need to restructure both revenue cycle operations and the IT support relationship to increase financial performance and patient satisfaction.

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OPPORTUNITY The network engaged Accenture to perform a comprehensive revenue cycle assessment, including a review of organizational leadership, Patient Access, Revenue Integrity (Charging), Coding, Hospital Billing, Professional Billing, Collections, IT support, HR processes and Training programs. Accenture was a natural fit to assess the network’s revenue cycle due to its extensive experience with EHR optimizations, revenue cycle recommended practices, and helping clinical organizations enhance their performance.

The health system’s ability to drive strong revenue cycle performance was impeded by the creation of system-specific processes during the initial EHR implementation, the need for stronger accountability and limited reporting capabilities. The organization’s most persistent issues stemmed from the following root causes:

LIMITED FOCUS on account stratification and prioritization of highest value accounts

INCORRECTLY RECORDED INFORMATION for insurance plans, COB, and eligibility

INCONSISTENT MANAGEMENT training on EHR reporting capabilities

LIMITED RESOURCES in the IT department dedicated to revenue cycle optimizations

LACK OF OPERATIONAL RIGOR and productivity standards for staff

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SOLUTIONAccenture worked with the network to transform its revenue cycle based on the following goals:

Accenture completed a comprehensive assessment of the network’s revenue cycle operations, which included EHR system evaluations, detailed account reviews, and more than 100 hours of on-site interviews. Accenture leadership reviewed the assessment results with the organization’s leadership team, and the network engaged Accenture to help transform their Revenue Cycle department.

The Accenture team began the transformation project by creating a list of initiatives that could be implemented quickly and could lead to the greatest financial benefits. These initiatives spanned both the Revenue Cycle and IT departments. The Accenture team drew on its diverse technical knowledge to prepare a prioritized list of system optimizations and interactive reports. A primary focus was to maximize automation and use existing functionality to replace manual processes. Accenture partnered with the Revenue Cycle Operations and IT departments to strategically prioritize key initiatives for overall improved workflows and system processes.

DECREASE accounts receivable (AR) and reduce net revenue leakage to increase cash collections

INCREASE accuracy of patient financial clearance and Point of Service (POS) collection processes

REFINE workflows and system tools to better utilize EHR system functionality and increase efficiency

DEVELOP and implement policies to help increase timeliness and accuracy of charge generation and coding

ACCELERATE revenue cycle processing times by reducing Candidate for Bill (CFB) backlogs, charge/billing lag days and days to final payment

CULTIVATE organizational structure that fosters growth, training, accountability, and change management

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Next, the team moved quickly to implement accountability structures across areas that posed the greatest risk to financial performance. This framework included new task forces dedicated to reviewing aged high-dollar claims, denials, CFB, and work-queue management, respectively. These data-driven task forces allowed area managers to present claim trends to their colleagues, enabling cross-departmental collaboration, goal setting, and identification of actionable training opportunities.

Accenture also leveraged its extensive revenue cycle management experience to help the health network achieve both industry and management recommended practices. Industry recommended practices include refinement of pre- and point-of-service collections activities, expansion of price estimator tools, creation of a Denials Specialist role, and the development of requirements needed to centralize pre-registration and authorization activities for ambulatory clinics. Due to the large scale, importance and complexity of these activities, the preparation and implementation phases took several months. In the first eleven months, point-of-service collections increased by roughly 40 percent (Figure 1). Management recommended practices include development of communication plans, shadowing and constructive feedback sessions to directors and managers led by Accenture, and creation of a workshop series on departmental management, including effective communications, goal setting, and Key Performance Indicators (KPIs).

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FIGURE 1. POINT OF SERVICE COLLECTIONS 2014-2016

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The Coding department faced significant challenges during the project. ICD-10 regulatory requirements were scheduled to go into effect only weeks prior to the beginning of the engagement. The existing stresses on the department were exacerbated by staffing vacancies. These issues appeared in the CFB metric, as roughly 90% of the total CFB population was with the Coding department at the project’s start. Focused efforts on high-dollar account escalations, work-queue consolidations and the usage of external coding resources helped reduce backlogs by roughly 85% (Figure 3). CFB days were at their lowest levels in five-years. Next steps included eliminating manual processes within the system and establishing higher accountability for productivity.

RESULTSAt the end of the project’s first year, client and Accenture teams had created significant organizational benefits by implementing new reporting capabilities, EHR system optimizations and industry recommended practices. These initiatives helped the health system generate $49M in incremental cash collections. Gross AR days decreased by almost 14 percent and are at their lowest since December 2015 (Figure 2), and CFB days have been reduced by more than 50 percent (Figure 3).

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FIGURE 2. A/R DAYS

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FIGURE 3. CFB DAYS

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Client leadership is happy with this progress and the results achieved to date. The Senior Vice President for revenue cycle stated,

We’re encouraged by the results over the last several months. For us, this is just the beginning of our transformation, and we’re looking forward to seeing continued positive results.

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ACCENTURE INSIGHT-DRIVEN HEALTHInsight driven health is the foundation of Accenture’s approach to more effective, efficient, and affordable healthcare. Our committed professionals combine real-world experience, business and clinical insights and innovative technologies to deliver the power of insight driven health. That’s why the world’s leading healthcare payers, providers, and public health entities choose Accenture for a wide range of services and technologies that help them use knowledge in new ways – from the back office to the doctor’s office. Visit us at www.accenture.com/health.

ABOUT ACCENTUREAccenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Combining unmatched experience and specialized skills across more than 40 industries and all business functions – underpinned by the world’s largest delivery network – Accenture works at the intersection of business and technology to help clients improve their performance and create sustainable value for their stakeholders. With 459,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives. Visit us at www.accenture.com.

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