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Success Story 4

Optimizing the Revenue Cycle

"We were looking for a more elegant solution than the software we had developed in-house, and it had to be able to handle a large, extremely complex organization in an increasingly stringent managed care environment.. PsychConsult was the only one that came close, because it integrates the entire spectrum of clinical and financial tasks: call center, scheduling, EMR, and billing."

"As we analyzed the structure of PsychConsult, we realized that it's developers understood a fundamental precept: The revenue cycle begins at the 'front end', when the patient first contacts a clinic or call center."

"In the end, PsychConsult lets us do more of what we got into this business to do: provide high quality care to patients. The results speak for themselves. On average, 90% of clinical documents are completed within 24 hours of the service. We saw an 88% decrease in denials and a 23% decrease in Days in AR. We absorbed a 26% expansion in our core businesses without a negative impact to our revenue or collections."

Overview of Best Practices

	Challenge	Solution	Success
Optimize Revenue Cycle	Optimize efficiency of revenue cycle Decrease claim denials Increase accountability for performance	Revenue cycle begins with clinical tasks Utilize full complement of integrated modules "Revenue-Roundup" team reports	90% of documentation is complete in 24 hours Decreased denials by 88% Number of days in AR decreased 23%
Core Business Expansion	Manage expansion	Central Call Center for all locations Phase paper-based units in slower with additional support	26% expansion in core business without negatively impacting revenue cycle Call Center handles 11,000 calls per month for 70 locations

Challenges and Solutions

For many organizations, the pressures of fiscal accountability and performance have increased in recent years. At Western Psychiatric Institute and Clinic (WPIC), the implementation of PsychConsult was a key component of an organization-wide effort to optimize the revenue cycle and expand our core businesses. We were looking for a more elegant solution than the software we had developed in-house, and it had to be able to handle a large, extremely complex organization in an increasingly stringent managed care environment.

Efficiency

We sought a software solution that would prevent the most costly inefficiencies in our revenue cycle. In particular, we needed to ensure that we produced 'clean' bills that did not result in denials due to things in our control, such as late submission, inadequate documentation or lack of authorization.

As we analyzed the structure of PsychConsult, we realized that its developers already understood a fundamental precept:

The revenue cycle begins at the 'front end', when the patient first contacts a clinic or call center.

In fact, PsychConsult was the only one that came close, because it integrates the entire spectrum of clinical and financial tasks: call center, scheduling, EMR, and billing. If software is to provide successful checks and balances for billing, it must begin that effort during the clinical stages. If we want to avoid a denied claim, we must ensure that an appointment is scheduled with a clinician credentialed by the patient's insurance plan; procedure authorizations are secured; and documentation is completed, signed and submitted within contractual timelines.

This is precisely where PsychConsult excels. We have taken advantage of a number of checks and balances woven into the core software:

• One centralized staff uses Call Center to search and schedule appointments for over 70 locations and are able to see conflicts and staff credentials at a glance.
• Provider prevents inappropriate services from being scheduled. The Fee Matrix allowed us to translate a complex charge master into detailed rules that will not allow someone to schedule a service that conflicts with a payor's requirements.
• Provider's automated triggers alert clinical staff when authorizations are missing and send templates of required documentation to personalized to-do lists for each clinician.
• Service records are reviewed by an automated Batch Processor, which flags the ones that contain errors that would result in a denied claim. Clinicians get a personalized list of errors so that they can correct them before a bill is ever generated.
• Inpatient information flows into our custom CARE Management inpatient application, which tracks the complex documentation required by approving agencies for continued stays. This is critical for avoiding medical necessity denials.

Accountability

In addition to these application-based safeguards, it was also necessary to address organizational issues of accountability. When you acknowledge that the revenue cycle begins during the clinical stages, it becomes clear that each group's performance has a direct effect not only on patient care, but the organization's financial health. It is critical, therefore, to be able to give each group information about their performance and factor in information about their experiences.

This is one of the greatest strengths of PsychConsult- being able to run reports to distill the important lessons from the vast sets of information collected in the database. We chose to share these reports across departments so that everyone was aware of how our daily activities were affecting the overall health of the organization. Affectionately referred to as "Revenue Roundup," we established bi-monthly meetings to review statistics on a number of measures. Representatives of each clinical department join staff from Medical Records, Registration/Access, Information Services, and Finance to review reports on the number of services in each department that are unbilled due to errors such as:

• unsigned documents
• missing authorization
• missing patient coverage
• missing diagnosis

Initially, people felt understandably anxious about having their department so publicly measured, but this has evolved into a very positive event. Our staff takes tremendous pride in their work, and the reports give them very specific indicators of places where improvement is needed. It allows them to draw on the problem-solving strategies of other departments. The financial leadership is better able to advocate for the organization with insurance companies. If we realize, for instance, that a number of departments have high rates of unbilled claims because they are waiting for authorizations from the same company, we address the matter at a higher level.

Expansion

A rapidly expanding business can pose a threat to financial resources and systems if not carefully managed. Last year, WPIC needed to absorb 224 staff and over 2,000 patients from the behavioral health unit of a local hospital that closed its doors. It was important to provide services to the patients in as seamless a manner as possible, but the new staff was coming to WPIC from a totally paper-based system. We knew we had to strike a delicate balance between scheduling services without interruption and training staff on a new application and workflow.

The Call Center was pivotal in managing this transition. We were able to quickly begin scheduling appointments for the new staff from our central Call Center facility. By having the schedules and credentials of all 300 clinical service providers searchable from one screen, we are also able satisfy and report on state Medicaid access standards. The group now handles over 11,000 calls per month for over 70 clinical locations.

We chose to introduce the new staff to the application in phases, allowing them additional time to get acclimated to working in an electronic environment. Askesis had previously built WPIC an online self-training guide for new hires, and it proved very beneficial for these less experienced staff. They were able to see animated demonstrations of different tasks being conducted on WPIC's system, which accelerated their understanding of the application as well as the overall workflow. An increase in administrative support was required to fill the gaps in the modules the new staff had yet to learn, but the gains made in productivity and growth far outweighed these temporary expenses.

Successes

In the end, PsychConsult lets us do more of what we got into this business to do: provide high quality care to patients.

The results speak for themselves.

• On average, there is a 90% compliance to the requirement that clinical documents are completed within 24 hours of the service.
• We saw an 88% decrease in denials and a 23% decrease in Days in AR.
• We absorbed a 26% expansion in our core businesses without a negative impact to our revenue.

About WPIC

For more than 50 years, Western Psychiatric Institute and Clinic (WPIC) has been a national leader in the diagnosis, management, and treatment of mental health and addictive disorders.

As part of UPMC, WPIC not only provides the most comprehensive range of behavioral health services available today, but is also shaping tomorrow's behavioral health care through clinical innovation, research, and education.

Considered one of the nation's foremost university-based psychiatric care facilities, WPIC houses the Department of Psychiatry of the University of Pittsburgh School of Medicine. WPIC's international reputation attracts quality candidates from the world's finest clinical and research institutions. In addition to teaching medical students and directing a five-year psychiatric residency training program, WPIC offers nine federally funded research training programs for pre- and postdoctoral fellows.

WPIC is also a training center for graduate and undergraduate students from more than 20 colleges and universities, representing disciplines that include nursing, social work, education, childcare, and art and music therapy. WPIC's commitment to research has made it an international leader in discovering effective therapies. Some of the most successful treatments that are now standard throughout the world were pioneered at WPIC.

WPIC currently houses six federally funded Centers of Excellence:

• Mental Health Intervention Research Center for Mood and Anxiety Disorders
• Conte Center for the Neuroscience of Mental Disorders
• Mental Health Intervention Research Center for the Study of Late-Life Mood Disorders
• Pittsburgh Mind/Body Center (Understanding Shared Psychobiological Pathways)
• Affect Regulation and Adolescent Brain Center
• Advanced Center for Interventions and Services Research for Early Onset Mood and Anxiety Disorder

As an academic partner of the University of Pittsburgh School of Medicine, WPIC and the Department of Psychiatry consistently rank first nationally in psychiatric research funding from the National Institutes of Health.

WPIC has consistently ranked among U.S. News & World Report's "Best of the Best" as one of the best psychiatric care providers in the United States.

 

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