How can we take charge of our A/R, effectively manage our reps—both on site and remote—and drive significant improvements?
It’s a common lament among revenue cycle leaders across the U.S: they struggle to accurately gauge (let alone increase) rep productivity. Data that show how much time reps are spending between calls, waiting to connect, or on the phone with payers lags at best—or, at worst, is nonexistent. Whether reps are making the most of every call is hard to determine.
Meanwhile, reps must decide on their own (without the context they need) which accounts to work at any given moment. It’s a daily burden that hinders their productivity and their ability to focus on high-value tasks.
Recently, at the Becker’s Healthcare HIT + RCM Virtual Event, Ontario Systems COO David Franklin sat down with the senior director of revenue resolution at one of the nation’s largest health systems. They discussed these and other stubborn revenue cycle challenges—along with a simple change that sparked an A/R transformation.
Back End of the Revenue Cycle: 3 Realities that Stall Progress
This health system’s 400 reps (known within their organization as “caregivers”) engage in insurance follow-up and denials management work while operating within the Epic platform. Until recently, work queues drove their efforts based on a limited set of variables. Caregivers reviewed accounts at their own pace before deciding how to proceed based on limited information.
Although team leaders were determined to improve productivity, performance, and morale, they couldn’t overcome the three major obstacles that stood in their way.
1. Caregivers deciding for themselves which claim to work next
Without the benefit of an assembly-line approach built into their workflows, caregivers had to discern which accounts to work, when to work them, and how. Work queues weren’t focused on specific actions to resolve accounts, and denials weren’t being routed to specific queues for proper resolution based on denial root cause.
2. Unproductive time between payer interactions
In addition to manual and fragmented upfront decision making, caregivers were spending a good portion of their day either on hold or navigating IVRs before connecting with payers. With up to 15 prompts in some IVR systems, and hold times of 10-13 minutes not being unusual, caregivers were burdened by an unnecessary ceiling on the number of accounts they could work per hour.
The A/R team was further hamstrung by a manual QA process, the need to refer to procedural manuals to work accounts, and time spent away from the account screen—all of which occurred outside the native workflow.
3. Lack of insights for team leaders and reps
Having to rely on limited, inconsistent, and frequently unreliable data meant team leaders lacked crucial insights regarding account activity, processes, and employee performance. Actual talk times, which accounts were being worked, and whether caregivers were following standard operating procedures were open questions with no easy answers.
Meanwhile, caregivers went into each call without the benefit of timely, valuable references such as a definitive list of accounts to be worked, payers’ specific requirements, and scoring guidelines, to name a few.
How a Simple EHR Complement Can Transform Revenue Cycle Performance
This health system integrated a simple tech solution that complements its existing Epic workflow and interface. Right away, they fundamentally changed how account follow-up is managed and how caregivers spend their days—all while allowing caregivers to stay entirely within the Epic ecosystem.
By eliminating inefficiencies such as unnecessary upfront decision making and lengthy hold times, this EHR complement allows caregivers to work more accounts per hour. They also have the tools they need to accomplish more on every payer call. All the while, real-time insights into caregiver activity and performance continually feed into automatic QA scorecards for a more robust performance management program.
No more unnecessary pre-call work
Decision making now happens in the system, as data is leveraged to determine the appropriate action on an account (e.g., payment by aging bucket). Because they no longer spend time prioritizing accounts and deciding next steps, caregivers are free to focus on value-added payer engagement.
Minimal wait before connecting with payers
With the help of a concurrent dialing tool powered by predictive analytics, the system itself now navigates IVRs and estimates hold times before routing calls to caregivers moments before they connect. While payer calls are in progress, a new round of calls is launched, and the cycle repeats—freeing reps to field calls as opposed to wasting valuable time on hold.
Making the most of every payer call
Caregivers miss fewer opportunities to follow up on claims while speaking with payers, as the system automatically queues other claims for the same insurer—all in an easy-to-browse multi-tab format. A “playbook” is also embedded in the workflow, helping caregivers adhere to standard operating procedures.
A virtuous cycle of improvement
A/R team leaders now have real-time insights, both at the individual caregiver level and across the team, on critical productivity measures including:
- Claims worked per call
- Average update time
- Manual vs. automated dialing
- Accounts worked as percentage of accounts viewed
- Active hours as percentage of total hours
- Average talk time
Caregivers are now able to receive timely, meaningful coaching, and automated QA helps drive steady progress. Both of these processes are key to keeping engagement and morale high, especially in a remote working environment.
The Results: A More Productive A/R Operation and a Stronger Culture
This health system now has clear, real-time visibility into accounts worked per day, accounts worked per hour, and active hours per day across the A/R front line. Every facet of claim follow-up offers insights that can be used to glean best practices, improve A/R processes, and continuously drive performance improvements.
This thriving team achieved remarkable results within just six weeks:
Going forward, this health system seeks to fine-tune processes and management procedures, expand caregiver teams, and use automation to improve processes and productivity beyond insurance follow-up.
Driving Substantial Gains—Without Ever Leaving Their EHR
Simply by complementing their EHR—and preserving the ability to work entirely within the EHR—this health system was able to drive substantial productivity gains in short order. They gained the capabilities needed to guide caregivers’ work and maximize their time, along with the deep insights needed to manage and improve performance.
Watch the full Becker’s Healthcare HIT + RCM Virtual Event session:
Do You Have What It Takes to Optimize A/R?
Your electronic health record system (EHR) plays a vital role. But it could be missing key capabilities you need to take charge of your A/R and optimize your revenue cycle. Get the EHR Platform Checklist, and find out where your gaps may lie.
Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.
© 2021 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.
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