Coding, RCM Outsource Service Helps Healthcare Providers Streamline Processes

By Christine Kern, contributing writer

Ovation Revenue Cycle Solutions adopted as new name for innovative UPMC business unit.

The University of Pittsburgh Medical Center has launched a coding and revenue cycle management outsource service for other hospitals and physician practices, bringing to the market capabilities it has developed in-house during the past eight years, according to a UPMC press release.

As Health IT Outcomes reported earlier, UPMC is now selling analytics which aim to help doctors deliver procedures at low costs. “The implications for patients, clinicians, and UPMC are sweeping — from better understanding of where and why variations in patient care are occurring to figuring out where best to invest limited capital. Until now, these decisions were based on industry-wide cost estimates that often bore little resemblance to reality,” said UPMC in a press release.

Ovation Revenue Cycle Solutions, a wholly owned subsidiary of UPMC, offers healthcare providers transactional and workflow services that automate processes and minimize manual intervention throughout the revenue cycle. The company also offers a new coding service that will help its customers make the transition to ICD-10 diagnostic codes.

Ovation was formerly called Prodigo Revenue Cycle Services, an 18-month-old company that grew out of UPMC’s finance department. Companies like Ovation are part of UPMC’s revenue diversification plans, which are developing at a time when reimbursement is shrinking for providing core health care services.

The service is intended to streamline processes and improve the quality of revenue cycle lines, according to April Langford, CEO at Ovation. Under the program, Ovation obtains discrete eligibility verification and claim status data that is available on health insurer websites that coders can use to improve claims submission/payment cycles. These include discrete eligibility data such as a patients’ progress toward meeting their deductibles and CPT code authorization that verifies that a service is authorized to be performed. To improve visibility into claims status, Ovation can deliver to clients proprietary codes needed to adjudicate a denied claim.

One aspect of the revenue cycle lines is the coding system. Medical providers have until October 2015 to transition to ICD-10 billing codes, but a growing shortage of coders is making the change difficult for some doctors. What’s more, the new codes are more complex than the ones in use. “The conversion to ICD-10 poses enormous resource, technology and financial challenges to all hospitals and exposes them to financial and regulatory risk,” Langford said.

“Ovation Coding has been tested successfully in facilities of all sizes at UPMC, one of the nation’s leading integrated health care delivery and financing systems, and across every hospital department. Our results demonstrate that Ovation’s unique coupling of coding resources and auditing technologies improves quality, lowers costs and reduces risk,” said Langford.

Ovation Coding’s features include:

• access to high-quality, scalable coding resources
• electronic review of all charts for risk and regulatory compliance, plus audits by Ovation quality assurance teams
• secure, HIPAA-compliant information technology infrastructure and disaster recovery
• customized implementation and continuous process improvement for clinical documentation
• comprehensive reporting
• proactive account management

In developing Ovation in-house and with other hospitals, UPMC learned how to reduce “Discharge, Not Final Billed” incidents where a patient is discharged but not yet billed because of missing or incorrect information from the patient, physician or other sources. The organization also has reduced costs and now is better aware of where it needs to over-audit and where it can under-audit, Langford says. UPMC also learned that there is significant variation in the market on the quality and cost of outsourced coding.