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A Specialty Group’s Revenue Cycle Automation Journey

Revenue cycle automation has been a process, not a destination for Columbia Orthopaedic Group, and so far, automated financial clearance and A/R workflows have improved efficiency.

Jacqueline LaPointe
By
Published: 02 Nov 2020

Revenue cycle automation has become a necessity for healthcare providers looking to provide high-quality, affordable care. But for many organizations, automation in the revenue cycle is still an aspiration.

Revenue cycle management is ripe for innovation and disruption, according to the majority of respondents to a survey recently conducted by market research firm KLAS and the Center for Connected Medicine. Yet, providers continue to face barriers, such as fragmented technology and even a lack of available solutions, the survey found.

“It’s definitely a process, not a destination,” says Gene Austin, CEO of Columbia Orthopaedic Group headquartered in Columbia, Missouri.

The group formed over 50 years ago by three physicians has grown, now boasting 27 physician practices in the area and a whole suite of healthcare technologies, including revenue cycle tools that help the growing group do more work more efficiently.

Just recently, the specialty group automated accounts receivable (A/R) follow-up using a workflow solution from software company MedEvolve. The solution queues A/R workloads for revenue cycle team members according to their expertise and areas of focus, Austin recently told RevCycleIntelligence.

“We have been live using that capability since the end of the second quarter, early summer, and that has worked very, very well for us. It allows us to cover more ground more efficiently,” the group leader explained.

In fact, automating A/R follow-up workflows has been so effective for the specialty group that it did not need to add another team member as expected. Instead, the group was able to reallocate staff to other areas to “get more work done,” according to Austin.

“It also provides excellent metrics for us to determine the effectiveness of a team member, what their work has done, what they've accomplished and so forth, so it's a great benchmarking tool, as well,” the group leader stated.

Now that efficiencies have been realized in A/R follow-up, the group is working on automating the patient balance aspect of A/R.

It plans to use a solution that will similarly manage and set priorities for staff members to essentially structure how they work through follow-up with patient accounts, Austin explained.

Patient balance follow-up is the next stop on the group’s revenue cycle automation journey, but it certainly is not the last, Austin indicated.

Automating with the patient in mind

Columbia Orthopaedic Group has been building on automation gains in this manner for some time, setting goals for revenue cycle automation, testing and implementing solutions that work, then moving on to the next area using lessons learned. But overall, this revenue cycle automation journey has the patient in mind.

“It's all about the patient experience,” said Austin. “How can you make it more convenient from scheduling to reminding patients to get here, to once they're here, how can you enhance not only the financial part of the transaction but patient education and so forth?”

To that end, the specialty group is focusing on automated revenue cycle tools that enhance the unique patient experience of orthopedic medicine.

“One of the challenges that that we face is just the nature of orthopedics and the fact that, of the patients we see over the course of the year, close to half of them only come in once or twice,” Austin elaborated.

With such limited patient engagement, the group’s ability to effectively train and implement automated solutions is a challenge.

“We've got limited opportunities to implement and train them on that process but that's one of the challenges that we're trying to address,” said Austin.

The group is keeping this in mind by prioritizing front-end improvements through automation. For example, it is in the process of automating financial clearance, from eligibility and prior authorization verification to the generation of patient financial responsibility estimates and upfront collections.

With increased automation on the front-end, the group is not only able to clear patients financially for their upcoming procedure and get a jumpstart on collections and other back-end functions, but also keep patients engaged and educated. The group can also realize these efficiencies on a larger scale than before when staff had to do it manually based on the schedule.

“It's one of the only industries I know of where the consumer does not generally consider himself to be the payer for the services,” Austin stated. “We’ve got this third party and nobody, historically, has been expected to pay until after the fact, sometime well after the fact.”

This has led to substantial lag between time of service and account resolution, which has been an enormous challenge for providers trying to capture revenue in a timely manner. Front-end revenue cycle automation is key to overcoming the challenge by optimizing processes at the time of service to prevent headaches and rework on the back end of A/R management.

Automation is also supporting the cultural shift that is required to truly improve the financial experience for both the provider and the patient.

“Folks come to realize that, no, it's my healthcare, and yes, I may have insurance products that are going to help defer some of the costs, but ultimately it's the patient who's going to be responsible,” Austin stated.

Getting closer to the destination

The industry is still in the midst of both the technological and cultural shifts needed to achieve a seamless patient financial experience. But Austin is confident that the industry is going in the right direction with new automated solutions.

“In the perfect world, it would be nice if we could get out of the patient statement business,” Austin explained. “It would be nice if a patient came in and registered, provided their credit card, debit card, or HSA, and we could adjudicate their insurance claim and they automatically hit their means of payment. And that would all happen seamlessly. I’d like to think that we would get there at some point.”

That stop on the revenue cycle automation journey may not be that far off.

In the KLAS and Centered for Connected Medicine survey, over half of providers said they are confident in the industry’s ability to innovate revenue cycle management in the next year.

One of the primary reasons why providers optimistic about more automation coming to the revenue cycle soon is COVID-19. The pandemic is creating a more pressing need for efficiency and revenue capture. But the patient financial experience and consumer demands for a more seamless encounter are also driving disruption in this arena, providers said.

This could be a sign for providers to invest in their own revenue cycle automation journeys.

“Things that we're working on now that are nice to have, down the road not too far away, will be requirements instead of neat features,” Austin concluded. “They're going to be required for somebody to be effective in this arena.”

Next Steps

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