Strategies for a High-Performance Revenue Cycle

HCA, the parent company of Redmond Regional Medical Center in Rome, Ga., has made a concerted effort to enhance its collaboration and communications with insurers. In addition to verifying eligibility and benefits with payers on the front end, the system's regional shared services site in Atlanta recently completed a pilot with one of its largest payers to electronically exchange data.

The process involves using a shared, web-based relational database to provide claims information and status. Once the payer indicates that additional or missing information is needed, the shared services center uses a secured site to automatically provide electronic copies of uniform bills, medical records, itemized bills, and implant invoices. The site also provides electronic copies of daily census information to the payer so it can confirm service authorization.

This pilot project was completed in February 2009. Given the project's success, HCA would like to expand the program. At present, eight facilities are served for one major payer at the Atlanta site; HCA has plans to add another nine facilities. In addition, the organization would like to work with other major payers to develop similar capabilities.

In Redmond Regional Medical Center's experience, the key to improving connectivity is to ensure that both providers and payers have dedicated IT resources available to work through these types of initiatives. The successful implementation of the pilot project required staff with an in-depth knowledge of security standards, firewall connectivity, and file transfer protocols.

Publication Date: Thursday, November 05, 2009