Many of the Academic Medical Centers that are our clients have experienced phenomenal success with the implementation of an EHS system. An EHS not only allows for sharing of information across interdisciplinary borders, but also streamlines the flow of information for both hospital and professional fee charges.
The cornerstone of the revenue cycle in the EHS is the multitude of work queues designed and built to accommodate workflows from registration through denials management. Building work queues is a daunting task and that requires not only an understanding of the revenue cycle workflows in the current system, but effectively translating that work flow into an EHS. Our clients are generally pleased with their work queue builds, but often find that resource consumption was much more than was anticipated. In addition to the direct costs, there is a loss of man hours and productivity due to the necessity of building work queues translating to added internal costs.
The cost doesn’t end there! Poorly designed work queues can result in increased AR, missed charges, lost accounts and claim denials.
Often, as we have found with our clients, there is a huge difference between how we did business and whether these new work queues really reflect all of our work. Does the flow of accounts from work queue to work queue completely capture the entire revenue cycle work flow?
The bottom line is that poorly designed work queues prevent claims from getting out the door. Often, claims end up in back-end work queues and then must be reworked. This is an inefficient use of work queue functionality in the EHS and by the time those work Queue claim edits are unraveled, timely filing deadlines have passed.
Our clients have asked us to do several things that affect claims:
Clean up the work claims.
Figure out how the claims ended there
Do a root cause analysis of the cause.
Get the claim out the door by correcting the errors, such as the coding errors and clinical documentation issues (usually discussed with medical staff)
Lastly, work with the internal staff to correct or eliminate work queues. Obviously the most important thing is getting the claims out of the queue and out for billing.
Health Systems Management Network has provided these services for thirty years with each iteration of the coding schemes and the computerization of work flows. Our staff are Advanced ICD 10 trainers, Senior billers, although we prefer to work with internal staff, and finally our director of clinical data. Perhaps we can help sort through some of these issues and at the same time keep cash flowing.
Please do not hesitate to get in touch with us.