The revenue cycle initiative that turned into a long-term revenue generator because the hospital ensured project survival and success.
August 11, 2020
I have some friends with kids who are a couple of years older than each of my children. Developmentally and interest-wise, they are about one stage ahead of my kids. Frequently when we go to their house, they are getting ready to get rid of toys or other things that are just right for my kids. My kids love it, it's like Christmas every time we visit. It's even become a running joke − "Hey kids, we're going to the Romos! Get your backpacks!"
There's something to be said about being expectant and prepared. Kids are really good at this. This exchange reminded me of my earlier years at Databound when I worked with a client in a consulting engagement doing insurance discovery and verification. Like kids who know they are about to receive something, this client was good at preparing to be successful, which helped ensure that they were indeed successful.
For this project, we developed systems to perform daily insurance verification and insurance discovery for all their encounters. Basically, they wanted to make sure they knew about any insurance that a patient had to prevent missing out on any revenue that insurance companies owed them. But what was paramount to this client's success was that they guaranteed they were well-positioned to extract all the available value from the systems we built.
Now, as the Product Manager for BOOST™ insurance discovery, I didn't know how much of an impact this one consulting project would have back then. It not only inspired the development of our insurance discovery service but also taught me two big lessons when preparing for success.
1. Embrace change
Try it out
When we first piloted the project, they chose to perform discovery for one insurance payer and then assigned one person to make sure that this new insurance information turned into cash. This person was passionate about finding money for the hospital. She was the one dedicated to researching high dollar encounters and self-pays to see if she could find any insurance that might be responsible.
As they quickly saw success, we continued adding more payers, and they kept finding more opportunities to bill third-parties. This original analyst was able to deliver these results all because she had a powerful tool working for her by identifying both problems with existing insurance as well as finding unknown coverage. Our process of searching for coverage gave her a big boost (pun intended) in the job she was already doing. When the hospitals saw her success and how much money they were collecting, they created a small team to review the errors that came out of the insurance verification process and then add newly found insurance to encounters.
Check out Embracing Change on our blog for helping your health organization embrace change to support new initiatives.
Grow from your achievements
In the first year, our client collected $30 million with insurance discovery automation. With an extra $30 million coming in the door, no one balked at having a team dedicated to working insurance, and so the team grew.
Now, new hires are assigned to this team where they learn the EHR, learn about insurance, and ultimately help the hospital in a tremendous way. As the success of this project became clear, the hospital was ready to rearrange their staff and hire new staff to make sure they were able to cash in on this tool as much as possible.
2. Prepare others for success
The problem of silos
During my time as a consultant, I spent a lot of time working in hospitals with IT and business office folks. Having boots on the ground allowed me to understand more about how the organization worked. One of the major challenges I observed was that departments tended to operate in silos. Sometimes we would be working with one department for years before finding out that a neighboring department was struggling with some of the same problems we were solving in another area. Other times our projects would stall because one group was completely on board, but we didn’t have buy-in from other stakeholders.
Spread success across departments
For this big insurance discovery project, one thing the driver of the project started was what he called the "Roadshow." We intentionally spent time going all over campus, educating and preparing other departments for what we were doing. We trained registrars in many clinics to understand what our discovery and verification process was doing and made sure that they knew who to call when they had questions.
Our team even presented to the hospital CFO regularly to know the value this project was bringing. Of course, he always enjoyed the part of the presentation when we told him how many millions of dollars the insurance discovery process brought in. Ka-ching! Easy win for the hospital to gain sustainable business growth.
The Roadshow led to project awareness around campus, full support from the CFO, and insurance discovery embedded in the organization's culture.
The Result − Long Lasting Success
These are lessons that I want to keep in mind. By preparing for newly found insurance and improvements to insurance, and by building bridges between departments, this hospital continues to collect around $17 million per year – even now, 10 years after the project began. Nothing gets lost to timely filing, and they are confident that money isn’t being left on the table. I don’t know about you, but I’d get my backpack out for that.
How will you prepare for success in your next projects?
Ready to infuse your organization with revenue and make sure you aren’t missing any billing opportunities? Check out our new risk-free tool − BOOST: Backlog Search™ − giving you and your staff a chance to prevent missed billing opportunities.