With the ever-growing decline of the American healthcare economy, monitoring patient centered revenue cycles is a growing concern for healthcare organizations. Healthcare revenue cycles over the years have primarily rested on the shoulders of the billing department and the Compliance Committee to make sure precautionary steps implemented to mitigate areas of non-compliance. Even when an organization feels they have the necessary infrastructure set in place to addressing areas of non-compliance, there is always that chance of human error resulting in stiff financial penalties.
Implementing the right financial solution is a critical concern as bad debt increases, cash flows decline, and enactment of new government regulations. In the age of budding technology advancements, there is new and exciting technology to take the “beast of burden” from the billing department and places it in the hands of the information system to support staff of managing the revenue cycle and workflow processes.
[pullquote align=”full” cite=”” link=”” color=”” class=”” size=””]The revenue cycle is the process and flow of patient information (financial and health) throughout the medical practice’s system, concluding with the reimbursement the practice receives from the services rendered. [/pullquote]
The revenue cycle is the process and flow of patient information (financial and health) throughout the medical practice’s system, concluding with the reimbursement the practice receives from the services rendered.
Having a revenue cycle that is efficient and streamlined will increase productively and margins. Contrariwise, the opposite effect is painstaking when the wrong infrastructure is not set in place, resulting in the loss of profits, and decreased margins.
ZirMed is a revenue-cycle management company using information systems (IS) and information technology (IT) to better support healthcare organizations.ZirMed integrates complicated systems with cloud-based applications accommodating the most complicated healthcare organizations’ systems to improve process flow, increase staff productivity (no longer having to have to manually attend to every claim), and decrease the lag time for receiving reimbursements. Some of their major offerings include patient access, charge integrity, claims management, accounts receivable (AR) management, patient responsibility, and population health management.
In 2007, ZirMed conducted a study at the Louisville Orthopedic Clinic (LOC) and Sports Rehabilitation Center in Louisville, Kentucky, accessing 3 offices, 11 physicians, 3 advanced practiced registered nurses (ARPN’s), 4 physician assistant certified (PA-C’s). The PROBLEM was that high-deductible health plans (HDHPs) were creating large patient balances and a lag time that exceeded 45 days resulting in delinquent accounts. LOC used an expensive subscription-based service decreasing staff efficiencies, inaccurate patient balances, and the constant updating and change of fee schedules. The data were consistently out of date and unreliable to make decisions to increase process improvement. The NEED was to find an unwavering solution for patient estimations (i.e., patient out-of-pocket responsibility and concise information to pre-collect for services). The RESULTS was a process that increased workflow and revenue, along with answering patient questions about how much they owed and why. LOC now provides right patient estimates determined by their patient benefits. There is an overall reduction in collection costs, reduced accounts receivable (AR) days, less bad debt, staff time managed more efficiently, and improved understanding of payments and benefits.
In 2013, ZirMed conducted a study in a large hospital organization accessing 100 affiliated programs and 1,000 physicians in Palo Alto, California. Lucile Packard Children’s Hospital (LPCH) is part of Stanford Children’s Health (SCH) deals primarily with highly specialized process claims and monitored by staff and manual processes. LPCH SCH was outsourcing claims to multiple vendors creating a ripple effect hurting margins, decreasing staff productivity, and slowing down the speed of reimbursement. LPCH SCH used ZirMed’s claims management applications for claims processing and remit management solutions. The results were payments received within 45 days of service increased more than 20%, reduced paper claims by 70%, integration was seamless with existing system, and controlled for growth while not adding more full-time employees (FTE’s).
At the heart of every healthcare organization is an efficient and streamlined revenue cycle. Implementing the proper IS and IT infrastructure will modernize revenue cycle systems to create improved outcomes. Regulatory compliance is at the heart of the revenue cycle and not staying current will result in potential sanctions. The changing environment of financial incentives associated with electronic health record implementation is growing along with responsibility of the compliance team to carry out infrastructure to accommodate the change.
ZirMed (2016). Case Study: Louisville Orthopedic Clinic and Sports Rehabilitation Center, PSC. Retrieved from http://public.zirmed.com/wp-content/uploads/2016/01/Louisville-Orthopaedic-Case-Study.pdf?submissionGuid=ea18c22f-237c-4a15-9e88-1c5f829d4c26
ZirMed (2016). Case Study: Lucile Packard Children’s Hospital (LPCH) at Stanford. Retrieved from https://public.zirmed.com/wp-content/uploads/2015/04/Client-Story-Lucile-Packard-Childrens-Hospital-at-Stanford-1.pdf