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How Nebraska Medicine Boosted Revenue Cycle Efficiency

Automating key financial processes was key to allocating resources and improving revenue cycle efficiency at the large academic health system.

Jacqueline LaPointe
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Published: 08 Jan 2020

For an academic health system with 8,000 employees and $2.9 billion in revenue, running an efficient revenue cycle is paramount.

Nebraska Medicine is a large academic health system with two hospitals and about 40 specialty and primary care clinics, with partial ownership of two rural and one specialty hospitals. The health system also serves as the primary clinical partner for the University of Nebraska Medical Center.

The sheer size and scope, along with its many awards and recognitions, has allowed Nebraska Medicine to reach patients across all 50 states and even beyond. The health system manages about 31,000 discharges a year, as well as approximately 600,000 outpatient visits and over 1 million clinic visits.

While this growth is positive for the health system, it has also led to some revenue cycle management challenges.

“We've grown over time, which is a good thing, but you can't grow from an expense standpoint above what you're bringing in from that growth,” Jana Danielson, MS, FHFMA, executive director of revenue cycle at Nebraska Medicine, recently told RevCycleIntelligence.com.

Despite widespread growth among health systems, hospitals are not as profitable as they once were due to rising expenses. Both labor and non-labor expenses continue to increase, which is putting more pressure on hospitals with declining clinical volumes.

“Things are not getting easier from an operating margin perspective for hospitals, and we really need to focus on areas that bring value to the patient and to the organization,” Danielson stressed in her interview.

In order to that, revenue cycle teams need to focus on resource-related efficiency, she said.

“We want to do the best practice across the board, so how do we do all of this with the same resources we have today? Through streamlining processes and making things more efficient,” she emphasized.

Hospitals and health systems are constantly striving for efficiency, but it can be hard to come by for revenue cycle leaders. In Black Book’s most recent CFO survey, the majority of leaders said that less than one-quarter of their hospital’s transactional work had been automated in the last decade. Additionally, nearly one-third of the leaders said none or close to none of their financial work had been digitized in the last two years.

Using technology to support revenue cycle processes that a human does not necessarily need to do is key to overcoming operational and financial challenges in the face of growth, Danielson insisted.

Automating the revenue cycle

Nebraska Medicine has always been at the forefront of health IT innovation. For the third time, the College of Healthcare Information Management Executives (CHIME) named the health system’s medical center as one of the “Most Wired” healthcare organizations. The health system also recently announced a partnership with Nuance and Microsoft to implement ambient clinical intelligence technologies to improve clinical documentation and showcased its data center automation efforts in a recent HIMSS report.

These types of automation efforts have allowed Nebraska Medicine to focus more of their attention on patients rather than processes, Danielson stressed. And she is applying that strategy to the revenue cycle.

“We're using our resources in a manner that's focused on things that take away human intervention for analysis, problem0solving, and similar activities,” she said. “How do we make things flow without human intervention requirements to put the focus on counseling patients upfront or providing documentation education for providers, all of those types of things.”

One area in which the revenue cycle automation strategy has succeeded is claims management.

Nebraska Medicine recently implemented a claims analytics tool from the SSI Group that allowed the revenue cycle team to dive deeper into their payer billing practices. Specifically, the tool gave the health system granular data on claim denials, so revenue cycle teams could easily pinpoint denial rates by payer, first-pass denial, partial denial, and so on.

“It presents that information to us in a manner that allows us to pick those things that we can quickly impact, so that we can use our resources wisely,” Danielson said.

For example, if the analytics tool identifies a problem with subscriber IDs, then Danielson and her team can take the report to the health system’s claim team to see if they can populate the appropriate ten-digit ID to prevent future denials. The information from the tool can also help the revenue cycle team identify who needs education on creating clean claims, whether it be an organization-wide problem requiring monthly front-end staff education or an issue with a specific department requiring more personalized, one-on-one training.

Just by implementing a claims analytics tool, the health system was able to improve workflows and reclaim a full FTE by eliminating manual processes.

Picking the right technologies

To build on its successes, Nebraska Medicine plans to keep automating its revenue cycle workflows. That is one of the health system’s top revenue cycle goals of 2020, Danielson said.

But the health system is taking a more strategic approach to revenue cycle automation in light of interoperability issues.

Most hospitals use multiple systems and vendors for revenue cycle management, according to a recent HIMSS Analytics report. However, the more vendors used, the more likely a hospital is to report financial challenges, including higher denial rates, researchers found.

Implementing several different technologies as band-aids for revenue cycle deficiencies is not a winning strategy for hospitals and health systems, the report stressed. A lack of interoperability and integration among different technology systems will impact the bottom line.

To prevent interoperability and integration – or a lack thereof – from impacting revenue cycle performance, Nebraska Medicine is working with its current vendor partners to get the most it can from its existing systems.

“The biggest thing that we do to make sure that we don't encounter challenges is that we don't use a ton of different systems,” she explained. “For example, we could use somebody different for eligibility, somebody different for claims submissions, and somebody different for automated secondaries. But we're going to stick with somebody who is a great partner, so that we don't have a ton of different things going on.”

The key to this strategy is working with revenue cycle vendors. Danielson provides regular feedback to the health system’s vendors to let them know what is currently beneficial and what would be beneficial in the future.

“They take that information and continue to home in on things that give us as the provider the opportunity to get what we need very, very quickly,” she said.

Of course, some vendors are better than others with this. But it is that responsiveness that helps Nebraska Medicine determine which vendors they will continue to use as the health system continues to focus on automating processes to not only improve the bottom line, but also patient care.

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