By Tom White, Phynd Technologies
Health systems that embrace “Six Sigma” management techniques improve business processes by greatly reducing the probability that an error will occur. They subscribe to a “do it right the first time” ethos. Their culture drives them to evaluate and redesign processes to improve patient care while eliminating breakdowns and creating operational efficiencies.
The revenue cycle process has remained resistant to Six Sigma improvement. Upstream information gaps have – until now – prevented smooth claims processing and cash flow.
Let’s review a common breakdown. A patient presents at registration. The referring provider is not found by staff in the EHR or patient access system. The reg/sched team lacks tools to find the missing provider, instead creating an incomplete registration. Downstream, the revenue cycle, HIM and IT teams spend hours researching missing providers’ name, address, NPI, specialty, fax and phone number so it can be entered, post hoc, into the system. This class of breakdown has impact: twenty percent or more of receivables are delayed due to missing data.
Fix The Problem … Enroll Missing Providers In Real-Time
The root cause of this recurring challenge is that, today, patient access teams lack the tools to find and enroll that missing provider. They have no choice but to pass the problem downstream.
But what if staff could search for that provider and enroll them in real-time into their EHR or patient access system? Every registration would be complete, done right the first time. Revenue cycle, HIM and IT teams would be spared arduous provider research – no more lookups on NPPES, state licensing boards, Google, or phone calls to validate information. Data entry ticket volumes would vanish. Claims could be submitted without delays. Receivables would shrink. Cash flow would accelerate. You’d be a hero!
Fortunately, technologies are being deployed to address missing providers, using a platform which manages a health system’s provider, place and payment plan information. (EHR and patient access systems by design can’t manage providers, places and payment plans, as they are patient centric.) To fix the missing provider problem at the source, a system must:
The combination of a digital information management platform, integrated with an EHR, patient access or call center system to offer real-time provider enrollment ‘on the fly,’ may well make ‘provider not found’ extinct in the near future, and permanently remove one major source of revenue cycle bottlenecks. This class of software may well help revenue cycle teams drive days sales outstanding to new lows, freeing up cash so that health systems can improve their financial position to offset assuming a greater percentage of greater risk-based contracts.
About The Author
Tom White is CEO of Phynd Technologies. Phynd is a digital information management platform that gives health systems the power to normalize, centralize and transform provider, place and payment plan data into a single, digital profile of your care delivery network. Phynd dynamically serves up your network in a personalized web/mobile experience, continuously sharing updates with EHRs and other systems via an easy-to-deploy, modern API. Health systems using Phynd enjoy an improved consumer experience, increased utilization, more efficient registration and scheduling, reduced claim delays, reductions in data administration, and more efficient marketing and management of clinical networks.
Phynd clients include Yale New Haven Health System, Duke Health, UNC Health Care, University of Michigan, Orlando Healthcare, Kettering Healthcare, UC Irvine Health, and Houston Methodist. Phynd is an Epic App Orchard member. The Phynd 360° Platform is powered by Amazon Web Services. Learn more at www.phynd.com.