Case Study:
Lowell General Hospital’s Journey to a
Paperless Revenue Cycle
Lowell General Hospital
Presenters
• Bill Wyman,
Director of Revenue Cycle
• Sandra Clay-Hillyard,
Pre-Services Manager, Patient Access
• Michael McAuliffe,
Revenue Cycle Management
Managing Communication is Complex!
Scheduling Verification
Precertification
Case Management
Authorizations
Billing Inquiries
Concurrent Review
Eligibility
Patient
Hospital
Patient Instructions Pre-registration
Notification of
Calls
Discharge
Pharmacy Benefit Eligibility
Verification of Precert Call Center
Call Monitoring
& Training
Patient Status
Read-back
MD Office
Changes
Instructions
Communication
Customer
Service
Verification
Patient Satisfaction Calls
of
Benefits
MD Office
Payer
Notification of Admission
MD Orders
Physician Financial Counseling
Important Query Patient Out-of-Pocket
Message
Instructions
Protect. Prove. Perform.
Protect
Revenue.
• What really
happened?
• Where is our
opportunity?
Prove
Compliance.
• What went
right?
• Provide staff
support.
Drive
Performance.
• Fix broken
processes.
• Streamline
workflow.
About Lowell General Hospital
Patient Highlights
•Staffed Beds 179
•Inpatients discharged 15,693
•Patient days of care provided 53,537
•Births 2,371
•Diagnostic imaging procedures 147,223
•Laboratory procedures 1,163,440
•Surgical procedures 10,393
•Radiation therapy procedures 11,610
•Emergency services 48,931
•Outpatient clinic visits 27,559
Revenue Cycle and Integral Partners
• Patient Access
–
–
–
–
–
•
•
•
•
Central Scheduling
Pre-Registration
Financial Clearance Unit
Ambassadors
Patient Service Centers
Patient Accounts
Patient Financial Services
Imaging Services
Continuity of Care
Revenue Cycle Opportunities
• Physician Orders
• Patient Experience/Customer Service
• Billing/Denials
Physician Order Challenges
•
•
•
•
Lost Orders
Miscommunication
The Paper Chase
Denials $$$$
Brian Bailey – Manager, Ultrasound Services
The Solution
• Orders received
electronically
• Indexed to real-time
patient data
• Available to all users
at any time
Custom Fields
• Custom fields established
based on workflow
• Examples
– Insurance Group
– Physician Offices
– Service Lines
– Inside/Outside Referrals
• All fields are searchable
Fax Messages
Results
•
•
•
•
Streamlined workflow
Increased productivity
Physician satisfaction
Customer satisfaction
The Silver Lining
Patient Experience Challenges
•
•
•
•
•
•
No proof
The blame game
Delay of care
Scheduling discrepancies
Confusion about instructions
Complaints
Goals
• Minimize delays
• Eliminate patient reschedules for lost orders
• Maximize positive customer experience over
telephone
• Timely account satisfaction
Call Monitoring
• Professionalism
– Attitude, friendliness, communication skills
• Technical knowledge
– Ability to complete requested task
• Compliance
– HIPAA, standards of performance
& behavior
• Customer satisfaction
– Experience of: patient, doctor’s office,
insurance company, staff member
Anabella Silva – Supervisor, Central Scheduling
Voice Recording
• Options
– On-Demand
– Automatic
– Face-to-Face
• Scenarios
– Scheduling
– Registration
– Pre-Authorization
– POS Collections
Results
•
•
•
•
Improved QA process
Customer service improvement
Staff support
Improved patient throughput
Denial/Billing Challenges
• Communication with payers
– Pre-authorizations
– Admission notifications
• Communication between clinical areas and
revenue cycle
Admission Notifications
• No proof of notification
• No documentation of sender
• Denials
Carol McGowan – Supervisor, Financial Clearance Unit
Medical Records and Billing
• Slow, inefficient process
• Explored options for necessary improvements
• New process developed
– Streamlined and paperless
Deb Psaledakis – Accounts Receivable Rep
Results
•
•
•
•
Reduced net days in A/R
Reduced denials
Ammunition to appeal
Improved POS collections
Where are we now?
Where are we now?
• 3 successful deployments
• Infused revenue cycle initiatives into
clinical areas
• ROI
Areas of Expansion
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Cancer Center
HIM – Coding, Release of Information
Outpatient Nutrition
Endoscopy
Ambulatory Care Unit – Day Surgery
Pre-Screening
Operating Room Scheduling
Pain Center
Satellite Surgical Center
Cardiology
Sleep Lab
Center for Weight Management
HIM Audit Support
Merrimack Family Medicine
Q&A
Bill Wyman, Director of Revenue Cycle
bwyman@lowellgeneral.org
Sandra Clay-Hillyard, Patient Access
sclay-hillyard@lowellgeneral.org
Michael McAuliffe, Revenue Cycle Management
michael.mcauliffe@lowellgeneral.org