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    Applying analytics to revenue cycle management

    April 3rd, 2013

    In an increasingly complex healthcare environment, physicians must base financial strategies on more than assumptions and anecdotes. They need analytics.

    Frank Cohen presents a solid case for analytics in a recent Physicians Practice webinar, entitled Analytics Do Nothing for Your Practice’s Health – True or False?.

    People often use limited information – what they think is true – to make management decisions. This approach can lead to three pitfalls:

    Failure to observe – assuming you know what the problem is without seeing what is really happening

    Failure to plan – assuming you know how to fix a problem without first finding out what is causing it

    Failure to validate – assuming the action you have taken to fix the problem has worked without measuring it

    Diagnosing financial issues with evidence

    When physicians first assess patients, they may have some intuitive ideas about what’s wrong. To be sure, they will likely conduct tests, review lab results and consult other resources before diagnosing and prescribing treatment. In other words, physicians provide evidence-based care.

    Physicians should apply the same principles to their business practices. With a complex revenue cycle – involving patients, payers and an ever-changing array of code sets – it is critical to build processes that optimize profitability. In other words, physicians must use evidence-based management.

    Problem-solving with analytics

    As an example, let’s look at a practical problem:  We want to reduce days in accounts receivable. It’s tempting to just test practical solutions to this problem, based on what we think is going on. But we’ll increase our chances of a positive income if we apply analytics.

    Now, let’s translate the practical problem into an analytical problem. To do that, we’ll need to address several questions, such as: How should we define accounts receivable? How do we calculate our receivables? Do we use rolling 12-month averages? How are we projecting future receivables?

    We’ll need data for each individual step to develop an analytical solution. (In the webinar, Frank Cohen offers a workshop toolbox with data sets, articles and other resources to help with this process.)

    If you have the right tools, getting this data is simple. To help illustrate the power of analytics solutions, Cornerstone Health Care shared its experiences as part of the webinar.

    Cornerstone Health Care achieves better outcomes with business analytics

    Located in North Carolina, Cornerstone Health Care is a multi-specialty 375-provider group that serves 800,000 patients annually. Using Allscripts Practice PerformanceTM, a business analytics and comparative benchmarking solution, Cornerstone applied analytics to several areas.

    According to Penny Whitaker, business systems manager at Cornerstone, the solution provided insights in several key areas including reimbursements, accounts receivable, resource utilization, staff and physician coding, claim processing, payer performance and more.

    Practice Performance also provides Cornerstone with new capabilities that have helped them improve their financial and operational performance such as:

    Proactive email alerts that notify designated staff when key performance indicators fall outside an acceptable range;

    Interactive dashboards that summarize key performance indicators, and enable staff to quickly drill down into the details with the click of a mouse; and

    Comparative benchmarking charts that help the practice compare itself against peers by geography or specialty, and compare results within the different locations and departments at Cornerstone.

    Cornerstone used these insights to make informed revenue cycle management decisions. For example, team members looked at claim denials by location, including registrations, pre-authorizations and referrals. They were able to see the data from different perspectives, including comparing results among different offices.

    The result? Cornerstone identified new denial trends stemming from payer and regulatory changes. In one example, Cornerstone’s billing supervisor investigated denials from Medicare. Using analytics, she was able to quickly examine if the issue was affecting other payers and see the denial code volume. The team determined that a simple change to the claims format would address the problem. Cornerstone also identified new areas for training and improvements to the check-in and registration process.

    Stop guessing, start knowing

    As the webinar concluded, Frank Cohen observed that the healthcare industry is facing a monumental shift. If practices don’t handle data with analytics, they won’t be in business. If they’re not able to adapt, they won’t survive.

    For more information, listen to the webinar or contact Allscripts Solutions Consultants at 1.800.334.8534.


    12 questions to ask before selecting a revenue cycle management partner

    March 18th, 2013

    To control costs and improve results, many medical groups are evaluating a new generation of outsourced revenue cycle management (RCM) solutions. But wading through RCM solution options can be confusing.

    One obvious measure is the price of the solution. It’s important to evaluate the total cost of ownership to help make the right decision for your practice. Considerations should include the answers to these questions:

    1. Will the solution save staff time by automating time-consuming tasks with easy-to-learn software?

    2. Will the solution’s analytics give you insights to help you proactively manage the revenue cycle, provider productivity and benchmark performance?

    3. If you decide to make a change in the future, is the solution portable? Or will you need to start a new solution from scratch?

    4. Will your staff continue to perform certain tasks internally, or will your partner? For example, will you outsource tasks such as self-pay collections, patientstatements, appointment reminders and collection letters?

    5. Are there transactional fees associated with certain tasks, such as eligibility verification, electronic claim submission, reminder calls and other similar functions?

    6. Will the vendor provide phone support during all of your office hours?

    7. Does the vendor handle patient calls about billing questions, or is your staff required to manage all patient-facing issues?

    8. In addition to standard, static reports, does the solution offer more comprehensive, dynamic analytics?

    9. Does the solution enable you to easily distribute information to various constituents in your practice?

    10. Does the solution allow you to benchmark your performance against your peers?

    11. Does the vendor provide a dedicated account manager, who is accessible and able to answer and resolve issues quickly?

    12. Will the vendor bring new ideas to help improve productivity and keep you up-to-date on solution developments?

    Knowing the answers to these questions can help you choose the right RCM outsourcing solution for your practice, which will help streamline workflow, raise clean claim percentages and speed payments. Best of all, a good RCM outsourcing solution enables you to spend less time on billing and more time providing quality patient care.

    Have you recently implemented an outsourced RCM solution? What were your top considerations? Help your colleagues by leaving a comment below.

    Editor’s Note: This post is derived from Ed Wrzesinski’s recent article in Physician’s Practice.  Find out more about Allscripts new approach to revenue cycle management here.

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    Introducing Allscripts Practice Performance: Boost Your Business IQ

    May 24th, 2012

    Do you have the data and insights you need to better manage your practice and improve profitability?

    Over the years, the business of running a physician practice has become immensely complicated and labor intensive. Health plan rules and government regulations are constantly changing. And while it’s increasingly important to cut costs, increase efficiency and align compensation with productivity, it’s difficult and time consuming for practices to track these and other key success measures, let alone understand how they’re performing versus their peers.

    To help, today I’m really excited to announce Allscripts Practice Performance, a new business intelligence and comparative analysis tool that responds directly to our customers’ evolving business needs.

    Leading medical providers have told us they want a new generation of cloud-based solutions that give them actionable business intelligence. Allscripts Practice Performance delivers with a complete analytics and business intelligence solution enabling administrators to keep their fingers on the pulse of … virtually everything going on in their practice.  Now available for the more than 100,000 physicians using an Allscripts practice management solution, Allscripts Practice Performance provides actionable information to help you manage your business and immediately respond to changes in key reimbursement and operational measures.

    We give your practice a business IQ boost with:

    • Pro-Active Alerts: Customized insights, defined by you, are pushed to your email or smart phone, alerting you when a key performance indicator falls outside an acceptable range.
    • Interactive Dashboards: Summarize real-time measures for analysis with one-click drill down functionality for deeper analysis. Allscripts Practice Performance includes tracking for:
    • Cash Flow Analysis
    • Staff Processing Time
    • Aged Cash Analysis
    • Reason Code Analysis
    • Payer Processing Time
    • Unexpected Denial Rate
    • E&M Code Utilization 
    • Comparative Analytics: Measure your practice against your peers nationally, within your state, or within your specialty. With a database of over 30 percent of all remittances processed nationally, Practice Performance provides you with credible comparative analytics to gauge your performance against your peers. 


    Insights + Action = Outcomes

    One of the key differentiators of Practice Performance is the insights it drives. These are proactive alerts that are set up by the user and then go out on a selected schedule to let you know how you are doing on any measure you track. For example, you can set up an insight for each physician in your practice that will automatically email providers once a week to let them see how they are doing with their A/R, productivity, scheduling, etc.  The provider gets an easy-to-use view of their data and they can click on the graphics and drill down to a transaction detail level if desired.

    That is powerful! 

    But don’t take my word for it. Ask the business office at Cornerstone Health Care, a 325-provider multispecialty practice in High Point, NC.  Penny Whitaker, Cornerstone’s Practice Management Systems Manager, is now a confirmed fan of Practice Performance.

    Penny Whitaker of Cornerstone Health Care using Allscripts Practice Performance

    “What used to take two or three months to identify denials and other financial issues now takes moments,” said Penny. “Plus, we receive proactive alerts notifying us when something is trending poorly or is outside of the benchmarks we set. This is one of the strongest benefits of Practice Performance – we can quickly identify issues and trends before they become problematic and costly, and then take action to address them.”

    We hope the added intelligence in Allscripts Practice Performance will enable you to work smarter, not harder, while boosting the overall performance of your practice.

    QUESTION: If your practice has operational performance issues, how are you handling them?


    Four Steps to Physician Revenue Cycle Transformation

    March 1st, 2012

    Amid all the talk of Stage 2 Meaningful Use, Value-Based Care and ACOs at the HIMSS conference in Las Vegas last week, it was easy to overlook the dominance of the longest lasting trend of all in healthcare IT. Revenue cycle management doesn’t generate as much buzz as health reform but it’s still priority No. 1 for hospitals and physician practices nationwide.

    It’s easy to see why. As the latest Obama Administration budget indicates, reimbursement from payers including Medicare and Medicaid continues to decline. As a result, self-pay is on the rise, even as it is becoming harder to collect payment from patients, many of whom are struggling just to hold onto health coverage for their families.

    In this environment, effective revenue cycle management has become more important than ever. For help, many leading medical groups are turning to a new generation of sophisticated practice management applications and cloud-based RCM solutions. These end-to-end solutions not only increase automation, streamline workflow, raise clean claims percentages, and speed payments – they also provide actionable business intelligence that can transform revenue cycle operations and improve financial performance.

    The Four Step Methodology

    A white paper called “Four Steps to Physician Revenue Cycle Transformation” reveals how successful practices are using these technologies in tandem with a methodology designed to optimize their effectiveness.  The “Four-Step Transformation” methodology detailed in the white paper (also available from the Medical Group Management Association here)  distills best practices from hundreds of medical groups across the United States who leverage technology to improve their bottom lines.

    Tim Terrell, chief information officer of Cornerstone Health Care, a 325-provider multispecialty practice based in High Point, N.C., is an advocate of the four-step approach. Cornerstone uses a state-of-the-art practice management system that also leverages analytic tools to help the practice spot problems in the revenue cycle quickly.  

    “The problems are always going to change because the billing game is constantly shifting ground,” Terrell points out. “So what you want from your revenue cycle system are the tools to automate the process, plus the intelligence to reveal problems, and then the ability to respond and address them quickly. It’s a never-ending process but one that reaps big rewards.”

    The Four-Step Transformation methodology derives from the steps taken by many successful physician practices that have optimized their revenue cycles:

    • automate the basic RCM elements using practice management technology
    • apply analytics and business intelligence to the data generated by automation, uncovering meaningful insights
    • leverage insights to fix problems in the revenue cycle operation
    • constantly refine the process in a continuous quality improvement sequence

    For more detail, read “The Four Steps to Physician Practice Revenue Cycle Transformation.”  (Requires Adobe Reader).

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