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* Piedmont Healthcare
is on a multiyear journey to overhaul patient financial care so that all
patients are equipped with the information and options they need for a simple,
satisfying financial experience.
* The work is organized into eight initiatives, from
implementing a policy to address self-pay patient balances to transforming the health
system’s Patient Connections Center from a facility-based to a
* The health system’s goal of increasing patient collections
by $10 million over a three-year period is ahead of schedule, although
transformation efforts are still in progress.
Consumers increasingly expect
healthcare organizations to provide the type of convenience and efficiency that
they are accustomed to receiving from retail and other industry sectors. Moving
from “the way it’s always been done” to a customer-centered financial operation
requires a major overhaul of processes and protocols, as illustrated by the
effort at Atlanta-based Piedmont Healthcare.
Brian Unell, vice president-revenue cycle transformation
and integration; Allyson Keller, executive director of the Patient Connection
Center; and Andrea Mejia, executive director-patient financial care, will be at
HFMA’s 2019 Annual Conference, June 23-26 in Orlando, to present on the health
system’s “8 Initiatives to
Support Patient Financial Care” (part of the Patient
Accessibility, Engagement and Experience track). The eight initiatives are:
In this Q&A, Unell (pictured at right) provides an overview of the organization’s progress to date.
What does your job title — vice president of revenue cycle
transformation and integration — mean? How is Piedmont Healthcare transforming
its revenue cycle?
our revenue cycle operations operated with a disparate, decentralized model. While
our revenue cycle performed well by many metrics, we knew we needed changes to
accommodate our growth — we have doubled in size in the last four years — and
position us for greater success in the future.
see revenue cycle as a strategic, value-added function, not a cost-focused
transactional function. For us, that has meant launching eight initiatives — each
of which is a big undertaking — with the goal of moving the business in a
often people say, “I'm going to do point-of-service cash, and if I can collect
$3 more from 10,000 patients a month, then I've got $30,000 a month and
$360,000 a year, and in five years that's a $1.5 million initiative.” In my
view, if you focus on moving an individual metric, you can do it in the short
term, but it's not sustainable.
set the goal of trying to collect $10 million more in patient collections over
three years because we know just focusing on any single metric isn’t going to
be enough. We’ve already achieved $5.4 million in benefit in the first year,
and I believe there are more dollars out there that we’re going to be able to
collect as well.
How are your revenue cycle
initiative is working on our patient financial responsibility policy. We are
now in Phase 3 of that initiative. In the first phase, we started off with a
select group of nonemergent services — walk-in services like “I got sent over
from my doctor’s office for an X-ray or a lab test” — and focused solely on trying to collect at
least 15% of the patient’s responsibility up front. In Phase 2, we included some
scheduled services like surgeries and other invasive procedures.
the third phase, we’re going to focus on patients who are responsible for the
entire cost of their services because they either are self-pay or have high-deductible
insurance plans. We see that those patient balances are where we still have a
big opportunity to improve collections.
What kind of infrastructure
changes are you making?
of our biggest initiatives was a complete overhaul of our entire patient-payment
processing system — including point-of-service, preservice and post-discharge
payments that are made via the web, phone calls from patients to a staff member,
or an interactive voice-response system where patients can type in their credit
card number and pay a bill. We needed to be able to accept chip-embedded credit
cards, so we deployed nearly 900 new credit card machines. As you can imagine,
that was a pretty significant change for the 1,500-plus team members who take
initiative was to introduce a third-party financing option. We had historically
done in-house payment plans, but we are changing so that patients who need a
payment plan longer than 12 months will work through this third-party
What are you doing in the
area of patient financial communications?
initiative involves refining our estimates, statements and receipts so our
patients can understand them better. Although we have come a long way in
improving the patient financial experience, this is a journey we are continuing
to focus on.
used to be that patients in our physician offices would get two different
receipts — one from the credit card system and one from our electronic health
record system — so we have cleaned that up. The larger focus has been on our
consolidated physician-and-hospital patient statement.
fact, a few months ago our CEO was at a Rotary Club meeting and during the
Q&A someone stood up and said, “I have a comment about my bill.” At this
point our CEO was thinking, “Oh boy, here it comes.” But instead of complaining,
the person said, “I don’t know what you all did, but for the first time I can
understand my bill.”
patients can now opt in to receive email or text notifications about
statements. We went live with this option in September, and by January we had
over 10,000 patients opting for email or text notifications.
What is your Patient
Connection Center? And what are you doing to enhance that?
Patient Connection Center handles our scheduling as well as our preregistration
and authorization functions. Working on this was one of the first initiatives
we were aligned by facility, and we moved to a consolidated model centered on
service lines. Then we also went from what we called “days out” — if you are
coming in for an appointment, we want to make sure you’re preregistered 72
hours in advance, or three days out — to notifying patients of their liability
and completing preregistration during the scheduling call. If you have an
appointment four weeks from now, why should we be scrambling just a few days
ahead of that?
had another initiative related to that, which was redoing the job descriptions
for staff in the Patient Connection Center to support the service-line model.
What’s next for your
revenue cycle transformation?
next initiative is to optimize our scheduling and customer service calls. We
have implemented workforce management to understand how our teams should be
staffed to answer calls from our patients. We want to use speech analytics to
understand why our patients are calling and how we can meet their needs without
a phone call.
example, if 30% of calls are because patients don’t understand their bill, how
could we make it easier for them to understand? People calling us is not good
use of their time, and it’s really not good for us either.
game-changing initiative is the opening of a $600 million expansion at our
quaternary facility, Piedmont Atlanta Hospital. There will be no traditional
registration area. This is a major effort that we are partnering on with our patient
experience and hospital leadership teams to ensure our people, processes and
technology are ready to support self-service to complete the preregistration function,
given that there will be no place to perform this function — in the traditional
way — when the building opens in late 2020.
Lola Butcher writes about healthcare
business and policy topics for several HFMA publications.
Interviewed for this article: Brian Unell, vice president-revenue
cycle transformation and integration, Piedmont Healthcare, Atlanta.
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6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
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7 Steps for Building and Funding Sustainability Projects
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Key Capital Considerations for Mergers and Acquisitions
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Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
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Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
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5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
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Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
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Building a Clinically-Integrated Network
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Winning in the Post-Acute Marketplace
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Building A Common Vision with Employed Physicians
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
Practice Performance Improvement
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical Integration Without Spending a Fortune
Clinical integration can be expensive, but it doesn’t have to be, as this four-step road map for developing a CIN proves. Does it have to cost millions to initiate a clinical integration strategy?
Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
Adding Value to Physician Compensation
Today’s concerns about physician compensation are the result of the changing healthcare environment. The transition to value is slow, but finally becoming a reality. Proactive hospitals want to ensure that provider incentives are properly aligned with ever-increasing value-based demands.
This report focuses on the three big questions HSG receives about adding value to physician compensation; Why are organizations redesigning their provider compensation plans? What elements and parameters must be part of successful compensation plans? How are organizations implementing compensation changes?
Effective Revenue Cycle Management in Your Network
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing).
The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
Succeeding in Value-Based Care
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One common misconception is that the CIN can’t do anything significant until it has obtained the FTC’s “clinically integrated” stamp of approval. While the network must satisfy the FTC’s definition of clinical integration before single signature contracting for FFS rates and contracts can legally start, hospitals and providers can enjoy three key benefits during the development process.
Therapy: Benefits at All Levels of Care
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