An hfm Web Extra

The UPMC eCommerce (eReservation, eScheduling, and ePayer) technology was created by an in-house team of programmers. We first came up with the idea to create this technology by analyzing the root causes of our issues and determining how we could use automation to prevent issues from occurring. The greatest source of process improvement initiatives were found through analyzing our rebills, denials, and patient complaints.

After we identified the root cause of these issues, we took steps to improve the quality of these measures by proactively preventing them from occurring. We also analyzed labor-intensive, repetitive processes and evaluated automation potential to decrease manual efforts. For example, we were able to determine that many of our rebills, denials, and patient complaints were caused by incorrect insurance verification. Insurance verification issues could stem not only from manual errors, but also from the payer systems being down or an incomplete 270/271 transaction. Staff were not checking all available payer systems because it takes a lot of time, which they would not necessarily have when registering a patient. We recognized that not being aware of existing insurance or coordination of benefit issues were mistakes that were easy to make, yet easy to prevent. We saw the opportunity for the system to do the heavy lifting by accessing payer information, comparing it with data in the host patient accounting system, and presenting an exception-based work list for the staff.

Once we identified our highest opportunity areas, we started development of the UPMC eCommerce products. We began by building a programming team dedicated to the development and maintenance of the applications. The team originally consisted of two full-time programmers. As we refined and expanded the scope of the eCommerce products, we hired an additional three programmers. The increased salary costs incurred due to the hiring of the programmers have been offset by a reduction in FTEs required to work the reservation/scheduling/insurance verification pieces of work. In essence, the programming team paid for itself. Once the programming team was in place, it took them approximately nine to 12 months to create the eCommerce technology and get it up and running. However, it continues to be an ongoing process as we are constantly refining and increasing the scope of the products.

UPMC eCommerce is integrated into our technology infrastructure as a disparate, or bolt-on, system. It interacts with the scheduling, billing, and patient accounting systems using Health Insurance Portability and Accountability Act electronic data interchange (EDI) 270/271 transactions, screen-scraping/user simulation technology, and Health Level7 EDI transactions. We are able to send and receive data using these three main types of electronic communications and simply need to monitor the transmissions to ensure that they are being sent and received appropriately. One of the major draws of the UPMC eCommerce products is that they are bolt-on and are able to be integrated with virtually any patient accounting systems. Also, the design is such that staff are able to work accounts in any patient accounting system because the UPMC eCommerce product functionality is the same for all systems. 

For more information, see April Langford, Lyda Dye, Jessica Moresco, and Donald C. Riefner's "Improving the Revenue Cycle by Taking the Patient's Perspective," in the September 2010 issue of hfm.

Publication Date: Wednesday, September 01, 2010

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