Hayes Review: Fall 2008

Hayes' year in review

By Pete Butler

We have had a fantastic 2008, and don't see it slowing down anytime soon. I attribute it to the fact that we have smart clients who realize that creating operational efficiencies is especially helpful during tough financial times. This year, we were busy expanding the breadth of our services, adding industry experts to our teams and building lasting relationships with our clients. We now employ more than 100 full-time employees strategically dispersed throughout 28 states. Here are some of the exciting things we've been doing this year:

• Established the Technology Solutions division –

  This group of professionals has expertise creating data communication efficiencies for our clients through developing data integration models, programming solutions in Cache', M, GE Healthcare Objects, Intersystems Ensemble and more.

• Signed a partnership agreement with InterSystems –

  This partnership has allowed us to bring our clients to a new level of interoperability. Using InterSystem's Ensemble solution as a foundation, we are building single views across multiple clinical systems for physicians, and revenue cycle dashboards for executives to monitor their indicators in real time.

• Hosted our 2nd Annual MDaudit User's Meeting in Boston –

  Our billing compliance auditing software, MDaudit, provides both prospective and retrospective audit capabilities. This year, we unveiled the additional functionality of v3.5, an E&M utilization comparison of a provider's activity relative to normative data, including within their organization as well as national norms. MDaudit is being used by 43 organizations – seven of them listed in US News & World Report's "Top 15 Healthcare Organizations."

• Initiated development of MDaudit Hospital –

  We are actively involved with several client development partners to design and code our MDaudit Hospital software solution. MDaudit Hospital will be available for our clients in early 2009.

• Expanded our Epic presence –

  Our Clinical Services team has been very busy assisting clients to implement and optimize the EpicCare Ambulatory EMR. Additionally, we are leading a multi-affiliate EpicCare Ambulatory EMR training initiative, which includes participating on leadership committees, hiring training staff, developing training budgets, creating rollout strategies for each affiliate, etc.

• Enhanced our strategic services offerings –

  Our Strategic Services team has been working closely with our clients to define governance and implementation planning, provide guidance in pricing and strategy development for EMR offerings through Stark relaxation, and perform in-depth revenue cycle assessments and optimization.

• Increased our team by more than 20% –

  With our tremendous growth this year, we've learned that the best in the industry are choosing Hayes as a place to build a career due to the Hayes culture, e.g., "The Hayes Way"!

This November, the entire Hayes team will descend upon Boston for our annual Hayes Summit, where we'll brief each other on our latest work, share lessons learned and listen to industry guest speakers. We will also participate in Hayes University classes. "Hayes U" is our new professional development initiative aimed at keeping us sharp, in the know and happy to be at Hayes.

There is still time to apply 2008 budget dollars to business optimization. These days, it may be your best investment! I look forward to hearing from you, and wish you a great rest of the year.

Are you getting the bang for your EHR buck?

By Bob Bain

If your organization has an electronic health record, it has invested a tremendous amount of money, staffing, energy and political capital in it. How do you know whether you are maximizing your return? Your answers to the following questions may help:

Are your physicians and staff more efficient? Is the EHR helping your physicians and staff perform as efficiently as possible? Have you modified your workflows to take full advantage of the EHR product? Is the volume of tasks per physician and staff member overwhelming? Are they receiving tasks they don't need? Are the interfaces for orders and results working properly? Are the error logs overflowing with problems you don't understand how to fix? Is the staffing level appropriate for the automated EHR? Are the servers that house your EHR properly sized and upgraded to their most current versions? Are the EHR settings and dictionary items built properly?

If these questions illuminate concerns, there may be an opportunity to realize a further return on your EHR investment through optimizing your system's features, improving workflow or business processes, or providing additional staff training. Following are a couple of examples from our work.

One of our client's staff was not trained sufficiently in their new EHR's electronic tasking notes and refill requests. So, they relied on their old way - writing sticky notes to relay a message to a nurse or provider. Unfortunately, this is not only inefficient, but also results in a lack of documentation in the patient's record. Hayes provided staff training, revised workflows, and re-evaluated the system setup to optimize the features of the EHR for this client. These efforts improved efficiency and reduced liability.

Another client was ordering radiology tests but was unable to properly track the results. Staff could not always confirm a result had been received. This, again, was a liability and a customer service issue. We provided a solution utilizing the tasking component of the EHR.

As part of our optimization process, we evaluate a client's volume of patient visits, prescriptions, referrals and other aspects of the practice. We assess the timeliness of printing and faxing, and evaluate your hardware platforms. We also interview key stakeholders. Then we develop a list of recommendations and their associated benefits. Lastly, we can roll up our sleeves and implement changes. Some of our solutions have included:

• Creating a provider and staff user group to identify areas for improvement and open communication channels among staff and providers
• Improving in-house lab orders
• Enhancing the client's interface engine
• Automating patient letters

If you want to be sure you are getting the return on your EHR investment, just give us a call at 617-559-0404.

Ten ways to improve your revenue cycle

We recently asked our consultants to report back on the most predominant revenue cycle issues they see when working with clients. Their responses fell into four categories:

1. Registration and eligibility
2. Charge capture
3. Information systems
4. Denials tracking and management

Therefore, we wanted to share some tips and best practices in each of these areas. As an overall primer however, it is important to first map out the workflow and key processes associated with the revenue cycle. Then, benchmark your organization's results (i.e., A/R turnaround days, denials, etc.) against Medicare. Also, when making changes to your processes, it is important to involve senior staff such as the CIO or CEO. These senior staff members can help you work across organizational boundaries to ensure process improvement success. Finally, when making process changes, define who is accountable for following each process.

Often the best data to drive improvement in the revenue cycle lie within your charge rejections or your denials. In line with the four categories noted, we find that over 60% of all denials are avoidable if these ten procedures are followed:

Registration and Eligibility:

1. Prior to being seen by the physician, patients are fully registered in the system, and insurance and registration information is verified.
2. All authorizations and referrals are completed prior to the patient receiving service.
3. All patient account balances are reviewed 24 hours in advance, and a list of balances with explanations are provided to assist in the collection of co-pays and patient balances at time of check-in

Charge Capture:

1. Charge capture documentation is complete and accurate.
2. All charges are entered within 48 hours of receipt of service.
3. All payments and charges are reconciled and balanced on a daily basis.

Information Systems:

1. Charge interfaces are routinely reviewed for errors prior to claims being released.
2. Prior to charge submission, all claims are scrubbed for insurance edits and all claim edits requiring correction are resolved within 24 hours.

Denials and Tracking Management:

1. All payments posted and insurance denials are worked on a daily basis.
2. Denials and rework appealable claims are tracked in a timely manner to ensure maximum payment.

Our experience has shown that following these ten steps will increase your cash collections and decrease your payor denials. For more information about how Hayes can help you improve your revenue cycle processes and procedures, call us at 617-559-0404.

It's all in the appointment

In my experience as a consultant, most medical facilities focus their efforts on collecting payment after services have been rendered. More hours are spent evaluating accounts receivable than on finding better ways to collect payment up front. Yet collecting payment up front is crucial to ensuring that the facility gets paid.

Everything starts with the patient appointment. If accurate information is gathered at the time of the appointment, much less effort would have to be exerted after the charge has been posted. As time lapses, the likelihood of reimbursement diminishes. It is very difficult and expensive to collect once the patient has left the office.

A successful approach to collecting payment up front includes placing skilled staff at the check-in process. These staff members should have:

• Excellent people skills
• A solid understanding of insurance products billed by the institution
• The ability to communicate the institutional billing processes to the patient if needed

By placing these staff members at the front end of the appointment process, all of the needed information and co-payments can be collected. If an invoice does need to be sent later, the information will be correct and fewer hours will be spent in the follow-up process.

Managing interface resources

How do you apply project management techniques to the interface portion of implementation projects? The effectiveness of project management is not usually a key business metric. Yet ineffective project management can be costly. Understanding the unique challenges facing project managers regarding critical interface resources can ensure a timely and cost-effective software implementation.

The interface implementation aspect of a project is a project unto itself. Usually the interface resources at client sites are working on multiple projects simultaneously. In addition to their direct line manager, these professionals have dotted-line reporting relationships to several project managers who all have different agendas.

Keeping the Interface Project on Track

It is important that the project manager engage and keep the attention of the interface professional. Interface resources are a scarce and valuable commodity, and are in high demand not only for new software implementations, but also for maintaining existing applications. In addition, interface tasks usually appear on the critical path of most projects. It is therefore critical to keep interface resources on track as they will usually have multiple – and sometimes competing – priorities.

Tips for Project Managers

My experience with a recent pharmacy system software implementation illustrates some of the more successful project management strategies for engagements which involve interface work:

• Involve Senior Management:

  We asked senior-level staff to attend project status meetings on a regular basis. It gave the project the exposure it needed to keep it moving along on time.

• Create a Separate Interface Project Plan:

  The interface project plan had its own plan, with distinct goals and objectives that were coordinated with the overall project plan. It allowed the accomplishments and requests of the interface team to be clearly visible to all. This allowed the interface team to receive deserved attention; it also informed planning and expectations.

• Support the Project Team:

  Interface resources are pulled in different directions, and unless others on the team know this, they may feel that they're being dismissed. In addition to the project plan mentioned above, be sure to include the interface resources in overall project meetings, so the whole team knows what is going on. The interface team's update also serves to educate others.

• Involve the Interface Team ASAP:

  Even if formal interface efforts have not yet begun, ask the interface team members to be involved in the project planning. Their insight can be invaluable and save time later on, especially during testing.

When managing a project involving interfaces, this analogy can be helpful: Interfaces exist between systems, yet they enable the entire system to work. Similarly, interface professionals may not belong to a single team, but they enable an implementation. Managing these particular resources is critical to project success.

New online MDaudit™ client community

Hayes is excited to announce the launch of the new MDaudit™ online customer forum. This forum enables MDaudit users to:

• Network with peers in other healthcare organizations
• Share and learn best practices
• Access client support information

"The idea came from participants in our annual MDaudit User Group Meeting," says Andy Treanor, VP of Technical Services at Hayes. "People wanted to stay connected to each other between meetings."

To learn more about MDaudit and what it has to offer your organization, call 617-559-0404 or visit our website at www.hayesmanagement.com.

About MDaudit

By automating the administrative aspects of billing compliance auditing, MDaudit significantly improves audit productivity, increases audit accuracy and quality, maximizes revenue and provides a standardized, streamlined environment for compliance departments. It is currently in use at seven of the top fifteen healthcare organizations in the country, as identified by US News & World Report.

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