March 23, 2006
Process mapping is an improvement strategy that's ideally suited to the revenue cycle. As a multifaceted operation involving many intersects, the revenue cycle can be particularly prone to process challenges such as duplication, steps that don't add value, role or authority ambiguity, and bottlenecks. HFMA lays out the steps of process mapping in a new two-part educational report, sponsored by 3M Health Information Systems.
By developing an "is" map that creates an accurate and detailed picture of the existing business workflow, and comparing it with a "should" map that tells where the organization wants to go, providers are better able to:
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Identify productivity opportunities
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Identify best practices
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Conduct a root cause analysis of perceived challenges
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Create business workflow consistency
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Identify ownership and accountability
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Provide a means for consistent training
Process mapping can be applied to almost any process in the revenue cycle. For examples of ways some hospitals are using this improvement strategy, consider the following case studies.
Case Study: Reducing Demographics-Related Denials
New York-based Hudson Headwaters Health Network, made up of 12 community health centers, decided to reduce demographics-related claims denials by setting up and documenting a web verification process to enhance and standardize the way receptionists verify coverage status and demographics for commercially insured patients.
The workgroup for the project was an offshoot of a Patient Business Services Committee, which includes the CFO, COO, director of administrative services, director of patient business services, billing managers, and several lead receptionists. One of the workgroup's first tasks was to create a reception-related denials tracking report to get a handle on the denial rate.
After that, the group set a corporate target for 2003 to reduce the denial rate from 6.3 percent to below 5 percent and developed a new verification process, which featured the use of insurers' web sites. Over time, the process was refined to address problems that arose and put in outline form for receptionists to follow. (See page 2 of Real-World Applications of Revenue Cycle Process Mapping for the process document.)
For CFO Eric Burton, one of the biggest lessons learned involved the need to ensure appropriate feedback from front-line staff in developing or refining tools. "It turned out that the receptionists didn't even know how to decode the information on the sites," he says. "So we had to step back and create a training tool with process keys that spell out where the ID number is, where the date of birth is, etc. The tool was created by an IS staff person and that was really the turning point in making this process work." (See page 4 of Real-World Applications of Revenue Cycle Process Mapping for the training tool.)
In addition to reducing claims denials, the new process freed up time for the receptionists by automating a big part of the job; they had been spending a major part of their day trying to verify information for the next day's appointments.
Case Study: Implementing a New Information System
When Mercy Medical Center, Sioux City, Iowa, implemented its new information system, it needed to identify process issues and concerns in relation to its use. To do that, it created close to 100 process maps for patient access and PFS.
Each process was tackled by a small group that included both managers and superusers or key staff acknowledged as leaders within a department, according to Johnny S. Tureaud, director of patient financial services. "Previously, we had relied on policies and procedures -- general statements about what we wanted to do and outlines of how to do it. But this doesn't take into account any variations that may occur. Process mapping allowed us to really take a critical look at what we were doing and identify gaps or holes that we could then begin to address. Then we could build in policies and procedures to support the process flow." More than 40 processes were mapped in 18 areas just for PFS, right down to how to post a denial. This work was completed before the new information system was implemented, and the maps were used for training.
Tureaud aptly describes process flow as an evolving animal. "You design it and then once you apply it to the real world, you find that you need to make little tweaks and updates." An example is how Mercy's process of correcting errors in Medicare and Medicaid claims originally required the analyst to examine each claim for errors and determine where they should be sent to be corrected. "Once we identified the lab as a major source of these kinds of errors, we developed a report that identifies and automatically sends to the lab accounts that have a lab-related error."
SOURCE: Real-World Applications of Revenue Cycle Process Mapping, case studies by HFMA, sponsored by 3M Health Information Systems.
Additional Resources
SPECIAL ANNOUNCEMENT
HFMA wants to support members who wish to attend the Annual National Institute (ANI), but for whom personal or job-related hardships present special difficulties. Members may complete an application to request a one-year waiver of basic registration fees for ANI. HFMA volunteer leaders will review all applications, and a limited number of waivers will be granted, based on specific criteria. Get more information and complete the application.
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FREE CARE FROM NOT-FOR-PROFITS NOT THE ANSWER FOR THE UNINSURED, SAYS HFMA'S CLARKE
Attempting to solve the problem of the country's 44 million uninsured by requiring not-for-profit hospitals to provide more charity care, as increasingly demanded by lawmakers and state attorneys general, is "unrealistic and not in the best interests of the uninsured," wrote HFMA President and CEO Richard L. Clarke, DHA, FHFMA, in a letter Monday to the editor of The New York Times. On Sunday, the Times published an article on efforts by Charles E. Grassley (R-Iowa), chairman of the Senate Finance Committee, and Bill Thomas (R-Calif.), chairman of the House Ways and Means Committee, to set clearer standards for the community services expected from not-for-profit hospitals. Clarke wrote, "nonprofit hospitals are only part of the care delivery system" and cautioned that mandating free care to the uninsured would jeopardize hospitals' teaching, research, and community health improvement activities. "Instead, we need to focus our energies on dealing with the real problem: healthcare coverage for all." Read more.
Read Richard Clarke's letter to The New York Times -- and post your comments.
If you have questions or comments about HFMA Wants You to Know, contact editor Laura Noble.
HFMA Wants You to Know ISSN: 1540-0697. Volume V, Issue 6. Copyright 2006, Healthcare Financial Management Association. All rights reserved.