Optimize Your Revenue Cycle: Find and Eliminate Gaps

Last week I had the pleasure of speaking on our webinar, The Missing Gaps in Your Revenue Cycle Process, alongside our General Manager, Malachi Charbonneau.  

As a Project Manager at Medaptus, I work directly with many hospitals that each have unique charge management workflows and situations. When a new hospital is onboarded to our Charge Pro product, we do a deep dive into their entire charge management process, from start to finish.  

On the webinar, I covered a list of questions I typically ask Medaptus customers as we go through the process of auditing their revenue cycle process. If you suspect that you may have gaps in your revenue cycle process but aren’t sure where they are or what they are, start by asking yourself these questions. 

The answers to these questions can help you understand whether you’re potentially missing charges and uncover opportunities to streamline your charge entry workflow.  

1. How are patients assigned to the providers?  
2. Are patients assigned to the correct providers?  
3. Where do your physicians document their visits? 
4. Do mid-level providers have a separate charge entry workflow? 
5. How are your charges getting created? 
6. What information is included or required in your charges? 
7. Are there ways that you believe you can streamline your charge entry process? 
8. Can you implement one-click options for entering charges?  
9. Can information like places of service and patient type be set up in your system to get more accurate billing? 
10. Are there different indicators that could help you identify potential coding issues? 
11. What is your charge error correction process?  
12. How do your coders and providers communicate? 
13. How many people are reviewing your charges?  
14. Can any steps in your charge review process be streamlined or automated?  
15. How are your charges getting into your billing system?  
16. What does your charge reconciliation process look like?  
17. How many people are reconciling charges?  
18. Do you have a system in place to find any potential missing charges in your system?  
19. What is your lag time?  
20. What types of denials are you receiving in your system? 
21. Are there indicators that can be put in place to try and catch denials on the front-end? 
22. Do you have to wait until claims are denied to follow up and reprocess them? 
23. How many different systems are you using?  
24. What is the integration between your billing system, scheduling system and EHR?  
25. Is your insurance mapping from EHR to billing? 

After reviewing these questions, did you find any gaps in your revenue cycle process? If your answer is yes, don’t worry – you’re not alone! These gaps are more common than you think. The good news is, they can be eliminated by integrating a charge management system with your EHR. 

As I mentioned earlier, each hospital we work with has unique charge management workflows and situations. Our goal is to work with you to dig deep into what we can help you improve in your revenue cycle processes to ensure you’re capturing as much revenue as possible.  

Next Steps: 

• Watch the recorded webinar: The Missing Gaps in Your Rev Cycle Process 
• Book a demo of the Medaptus Charge Pro solution 

Webinar Transcript: The Missing Gaps in Your Rev Cycle Process
April 19th, 2022 

Vicky   

Hi, everyone, and welcome to today’s webinar, the missing gaps in the revenue cycle process. We’re excited to kick off today’s topic with two great guest presenters. My name is Vicky Abihsira. I’m the Director of Marketing at Medaptus and I’ll be moderating today’s webinar.  

First off, I just want to introduce our two presenters. Malachi Charbonneau, our General Manager. He’ll be talking a lot about the bottlenecks that he’s seen in the entire rev cycle, focusing on charge capture process, and why those bottlenecks exist, and what you can do to solve them. Hopefully, that will resonate with a lot of you. 

Our second presenter is Lisa Schwenker. She’s a Project Manager. She works directly with a lot of our customers on very unique workflows and situations, how they’re managing charges, and the entire process from start to finish. So she’s got some great insight on things that you should be auditing yourself, and asking questions about yourself, as you go through the process of figuring out if you’ve got bottlenecks, if you’ve got challenges, and how those can be solved. She’ll walk you through some of those common questions that she asks and things that she sees directly in the field.  We’ve got a couple great things that we’re going to be talking about today.  

We’re going to start off by talking a little bit about the challenges of the revenue cycle process. Specifically, we’ve tried to capture what those challenges are today, why they exist, and how you can better solve them. We’re going to talk a little bit about who’s involved in your process. So hopefully, again, you’ll see some of these familiar roles, and what they might be doing. And obviously areas where you can streamline that as well.   

Lisa’s going to then kick off auditing, looking at your workflows, what you can be doing a little bit better, and giving you some tips to improve as well. And then we’ll close off with a Q&A. We expect to probably be about around the half hour mark for today. Thank you again for joining us! I’m going to pass it off to our presenters to kick off today’s topic. 

Malachi   

Great. Thanks, Vicky. Vicky mentioned, my name is Malachi Charbonneau. I’m the General Manager here at Medaptus and I really appreciate you all joining here today just to walk through this. Hopefully this will be educational, and hopefully provide some insight into things that we’ve we’ve learned over time. 

So, as Vicky mentioned, just wanted to walk through kind of the baseline, the revenue cycle process today, as as we all see it, it’s large and complex. This image might look familiar to most of you, it’s probably actually a simplified view of the different things that happen when patients come in, either to the hospital or to an outpatient clinic. And these are all the necessary things that need to happen within the pre-service of the revenue cycle, but also at the time of so service and post-service to make sure that as the patient is seen and you can capture all of those charges. You can also build them out effectively.   

Where we’ve seen institutions kind of focus on these areas, probably a little bit broader than this. And they typically have initiatives that will streamline each of these different areas, and then also supply IT solutions to make sure that all these things are talking to each other. Because each step in the process can either hold up a bill or have some revenue leakage. I’m sure you know, the institutions that you may be working with have tried to address each of these different areas. And where we want to focus today is really at the time of service and post-service. There’s typically a gap in the revenue cycle that people often overlook.  

We’ve worked a lot in the charge capture and charge management space for over 20 years. And we’ve learned over time that there’s certainly bottlenecks in these areas that lead to revenue leakage, but also making sure that you have processes in place to make your teams as effective as they possibly can be by getting the charges captured and out the door. A lot of folks think it starts and ends with charge capture. But there’s a bunch of missing workflows that we’ve identified over time to make sure that from the charge capture, when the patient is seen, and you’re documenting all the information about them, to actually sending the bill out, there’s a lot of things that happen within your institutions, no matter what, and whether or not you have solutions in this area. It depends on how much time and effort you spend evaluating that. So there’s a difference between actually just capturing the CPT and diagnosis codes for an encounter, but then also making sure that as those things are captured all the necessary information, the demographic information, the fact that they have done their documentation, and the fact that you actually have a charge for all those encounters, and you’re reconciling all those missing, charges are critical to make sure that you’re getting reimbursed for every service that you’re supplying to your patients and your customers. I think of it as two major areas.  

You’re providing the service, let’s make sure that you’re, you’re identifying all those missing charge opportunities, following up with those providers and making sure that they’re documenting, but also capturing the charges. So there’s some revenue opportunity there.  And then depending upon your volume, how do you get all the charges that you’ve entered, cleaned and scrubbed, and then not only just sent into the billing system, but have it ready to be sent out to get paid. There’s a lot of those steps that need to occur to clean those charges. And there’s different resources that are needed to make sure that that happens. So a ton of these steps are often overlooked. Sometimes you’re handling it was spreadsheets, and you may think your EHR solution may even be able to capture charge. But a lot of these items are probably happening with a lot of time and effort spent by a lot of different resources. And as you add resources and different people trying to attack this problem, if you don’t have the right solution for it, you end up you know, having these bottlenecks, where you’re really not getting the labor efficiencies that you’re looking for, but also you may be missing charges as well.  

We’ve spent, like I said, the past 20 years understanding this process, and developing solutions for it as well. So we’ll walk through what we’ve seen and how to best address this revenue cycle gap area here, as we see it. As I mentioned, there’s the impact of not having a solution or not identifying this as a key area that you want to focus on, there are a ton of missed charges or lost revenue we’ve seen in this area. You know, there’s easy solutions, where you’re in the outpatient setting, where you have an appointment, you expect to charge, you still want some visibility into that, but especially when you get into the inpatient setting, when you’re rounding on patients, you may have attendings that are rounding, but also mid-levels that are doing team-based charging workflows. 

There’s also situations where you have a lot of consults for a lot of the patients that are in a bed, and making sure that you can identify the fact that a consult was ordered. The provider may have seen the patient, how do you know that the provider has seen a patient and that you should be expecting to charge and then making sure that that charge is captured, and then flown all the way through? A lot of these situations in this environment, if you’ve got disparate systems, especially if you’ve got different EHRs, or billing systems, you know, a lot of manual processes, making sure that insurance mappings map up, that the demographic patient IDs match up, you may be even capturing charges manually. But there seems to be a lot of time spent trying to find missing charges, but also getting the charges that have been captured entered into a billing system and sent out and paid. So a ton of opportunity to improve those workflows there. 

There’s also a lot of time spent, not only when you capture the charge, but the communication between typically practice managers or billers and coders on the cleanliness of that charge with the the clinicians that have entered it. So there may be a back and forth communication that’s happening, through text messages, non-HIPAA secure ways of communicating that you really can gain efficiencies if you had a solution where they can all communicate and make sure that those charges are clean, all in one system and in real time.   

We’re a big proponent of, to improve, you’ve got to be able to measure, and to be able to measure, you have to have the data to be able to have real time insights. Knowing where those bottlenecks are, maybe there’s folks who need some more additional training, you really want to understand where there is opportunity where you may be missing charges. There could be situations where they’re not documenting effectively, and you want to track all that information. So being able to have a system to measure all that, to track that in real time you can gain a lot of a lot of efficiencies there.  

We talked a little bit about, what does this really look like. In simplistic terms, let’s say the Dr. Jones in this example is seeing 10 patients today. They’re submitting charges. But what happens, when they miss the opportunity to bill to those patients? How do you identify that? Where we’ve been able to provide solutions is being able to identify all of the patients that have been seen, then identifying the areas where you may be missing charges. And then once those charges now have been entered, you have identified the missing charges, communicating back and forth to make sure that those charges are now entered by that clinician. And then as they’re entering those charges, what’s the cleanliness of that charge? Does it go through a scrubbing rules engine? Maybe a percentage of those charges are clean and can just be sent out right to the billing system right out to the payer without even being reviewed, if it hits all of the kind of the check marks to make sure that it’s a clean charge. So you can gain efficiencies for the percentage of those charges that actually don’t even need to be reviewed by a coding team or staff. And it can actually just be billed out. And then the ones that need to be worked are flagged and put into a work queue so people can actually work them effectively. Where we’ve seen this in previous institutions before we’ve worked with them is all of this is done in spreadsheets in a manual way where everybody’s reviewing everything. And there’s just a better way to do that to make sure you can gain efficiencies with the staff that you had, especially when you know the revenue cycle teams are being asked to do more with less. And the technology solutions should be able to provide efficiencies in these areas. So you can actually create work queues, create systems where you’re not having these bottlenecks, or having to review every single thing. That’s the intent of these information systems. And that’s what they should be doing in these different parts of the revenue cycle.  

So, as I mentioned, there’s a lot of different folks that are involved. And there may be more than this, but we tried to document the ones that we run into all the time. Whether that’s the clinicians, practice managers, sometimes there’s actual independent billers, who would have that specific role. Some of these folks may be having dual roles. So the practice managers may be doing the role of the biller. And the first line of coding. You may have some data entry folks, as you’re looking at this more closely, who’s adjusting information just to make sure that the systems line up if you’ve got disparate systems. Obviously the providers that are inputting the charges, the whole surround of the professional fee, but also making sure that you’re accommodating all the value based care programs that you may be employed in, whether that’s MIPS or bundle payments, BPCI or HCC coding, there’s a number of these different value based carriers that are integrated into the documentation and charge capture components that you need to make sure that you’re accommodating as well. There’s a number of different coders who are involved – revenue, integrity, compliance. So there’s, there’s a myriad of different folks who are involved here. And each has their own intent and what they’re doing. But some of them are using EHR, some in the billing system, and there typically isn’t, you know, one solution that fits the needs of all these different roles, and it’s hard for them to communicate and gain visibility into this whole process.  

As you’re looking at evaluating your charge capture and charge management process, you know, don’t stop at just how are the CPT and diagnosis codes being captured? I think you really want to take a look at how all of these different resources involved in your charge management process today. And what are they doing? What systems are they using? And what do they need out of the workflow? What is their intent? And what are they trying to drive towards? Because each of them have different responsibilities. But they’re all integrated into making sure that you’re getting reimbursed for all the services that you’re being provided in a in a compliant way, and you’re doing it in an effective way. And there’s a lot of different moving moving parts here. So with that, I think it translates nicely into Lisa’s workflow evaluation that she conducts on site. 

Lisa, I just teed you up for just some of the questions that we work with customers on. We really do a current state analysis and know how you’re addressing these different challenges today. I’ll let you take it from here. 

Lisa   

Great, thanks. So asking the right questions and breaking down each step of your revenue cycle process is really a great way to find workflow gaps, and different areas that can be improved. So right here, you can see we broke it down by a few different categories.  

So provider workflow, the charges themselves, reconciliation, denials, and your different system integration. So some of the questions that you may want to ask – How are patients assigned to the providers? And are they assigned to the correct providers? This can really tell you if you’re able to get an accurate list of which providers are seeing each patient and the ability to potentially find missing charges, and to make that workflow easier for your providers to do the charge entry itself. 

Where do your physicians document their visits? Do the mid-level providers have a separate workflow that needs to be addressed when they’re doing their charge entry?  How are your charges getting created? What information is included or required? Are there ways that you can make that charge entry process easier? Can we streamline it? Can you do different maybe one click options for getting your charges entered? Can we look at things like places of service and patient type information that may be set up in your in your systems to get more accurate billing? Are there different indicators we can put into the system to say here are potential coding issues? What is your charge error correction process? Is there communication between your coders and providers? How many people are reviewing your charges? Can any steps in this process be streamlined or automated? How are your charges getting into the billing system? What does that reconciliation process look like? And how many people are reconciling charges? Is there a system in place currently to find any potential missing charges in the system? What is your lag time? What types of denials are you receiving in the system?  

Again, are there indicators that can be put in place to try and catch those on the front end? So that way, you’re not having to wait until they get denied to follow up and reprocess those bills? What does your integration look like? How many different systems are in use? What is the integration between the billing system, scheduling, EHR? Is their insurance mapping from EHR to billing?  

Having one system where all of your different information can be centralized can really make for a more streamlined workflow. So asking yourself these questions and really breaking down the current workflow and processes in place can really tell you a lot about things that aren’t working and areas that potentially can be improved. So these are things that we look at when we’re starting to work with new customers, to really dig into what we can change and what we can improve and make better. 

Malachi   

Thanks, Lisa. And I think, you know, as you’re asking each of these questions, it raises more questions as you dig deeper. You just scratched the surface here, on all the different things that we ask our clients and work with them to understand their workflows. But as you as you start to dig in, you understand where there’s bottlenecks and then where you can gain efficiencies. I like the one that people seem to overlook, but it’s, what’s your charge lag? Folks, I think, just think that that’s how long does it take from your data service to actually get the charge build out, right. But it really is a, you know, an indicator, and it’s also like a proxy of how healthy your revenue cycle processes for any of those different areas. If your charge lag is high, there’s something happening within that whole stream, whether or not the providers entering it in on time, it’s not being reviewed timely, there might be data gaps, or maybe communication gaps. So looking into those things at a deeper level, will give you really the insight that you’re going to need to help make decisions on how to make it better.  

All right. So I just want to leave with a couple of key takeaways. Is this worth investing in? Everyone is trying to reduce revenue leakage. And there really are a substantial amount of missed charges and inefficiencies in the process that you would identify. There hasn’t been a customer that we’ve worked with that hasn’t had mischarges in some of the areas that they’re providing services, or just efficiencies to be gained in their whole revenue cycle process. Maybe that’s a timely filing issue or they can’t get a charge out the door and they just lose the opportunity to bill it. So there’s a ton of revenue opportunity.    

If you’re looking at how do you staff your different areas, we’ve worked with organizations who have centralized their billing operations and have really gained a lot of efficiencies by using the rules engine and work queues and making sure that they have a real system in place to manage their higher volume. You can gain a lot of efficiencies even if you don’t restructure your groups, you’re still going to gain a ton, making sure that you understand how the charge from the time it gets actually captured to billed out, how it’s actually working its way through that part of the revenue cycle. And then making sure you’re always consistent, you know, constantly improving in those areas, and how you measure things around that. It’s hard to measure the areas in this item, because the the EHR doesn’t really provide solutions for it. You capture a charge, and you can make sure that you can send the fee out. But everything that happens in between there, there’s a lot of insight you can that can be gained and how to improve the operations there.  

Having a system in place to be able to track that in real-time is going to be able to gain the financial and also labor opportunities that you’re looking for. Hopefully this was a helpful quick overview of things that we’ve learned. You can get pretty deep into each one of these different areas. Hopefully, this provided some level of insight into where we focus a lot of our time and effort with our customers. Alright, Vicky, back to you. 

Vicky   

Thank you. I thought that was really insightful. And I think especially hearing some of the things that you guys have both seen really helps put things into perspective around areas that you guys could be looking further at in your own rev cycle processes. So thanks for going through the challenges Malachi and Lisa the auditing and questions to be asked. We are going to take a couple of questions, and then we’ll wrap up for today. This webinar is also being recorded. So you will receive a copy of the recording, if you’d like to share it with anyone else at your organization.  

So the first question was for Lisa. So as you’ve probably encountered a lot of people using a lot of different systems, and we walked through as well, a lot of the different people that are involved. So there’s really a lot of different people, systems, maybe even multiple EHRs that people are using in one one hospital, one physician group, how can this really be streamlined? What are some of your recommendations for approaching something like that? 

Lisa   

Yeah, sure. So we have a lot of customers who use multiple different systems, whether we’re talking about multiple registration systems, multiple EHRs, multiple billing systems, and workflows. So we really can accommodate all of those different items, as well as with different types of interfaces, whether it be you know, ADTs, SIU, DFTs, flat files maybe bringing in consults or bringing in rounding lists or documentation into the system. So a lot of our customers really do use many different systems across multiple different facilities that we can then bring in and have kind of one, one central system that’s going to house all of that information to really keep it organized, and keep it streamlined, and make it as easy as possible for your staff to work charges and get everything in one place.  

Vicky   

Great, and then the second question we’ll take over here. No, Malachi, you touched on this briefly at the beginning, but why can’t EHR solve some of these challenges that you walked us through early on?  

Malachi   

EHRs do a lot of great things. And there’s been a lot of investment in them over time, obviously with the High Tech Act, and just in general, but their their main focus is really patient-centric and documentation-centric, and they’ve been building some tools around revenue cycle operations, but haven’t really focused in on this area. We’ve spent the better half of 20 years in this in this space, and they really weren’t built originally are designed for that. And this has been our sole focus for the past 20 years. So we’ve walked into institutions that have an EHR, even charge capture within their EHR, and they’ve got a whole host of different issues on the charge management side, the communication side, the visibility side, so it doesn’t just start with start and end with the charge capture component, even with the folks that are using EHR charge capture. So, they’re trying to pick the high value areas to focus on, they just can’t focus on all of them. So that’s where we’ve been able to help fill the workflow gaps. 

Vicky   

Make sense. Thank you. Well in the last minute that we’ve got here, I just want to quickly recap a little bit about who we are and what we do for those of you maybe who  aren’t as familiar. We have three main solutions that we offer.  

Our first one, that we’ve talked a little bit about today is around this the charge capture side of things. It’s called Charge Pro. That’s what you might be looking at if you’re still looking to solve some of these rev cycle challenges that we talked about today.   

The second one is Charge Infusion, which is specifically revenue capture for infusions billing, which as we all know, can be very complex and confusing and very manual as well. So a lot of things that we do to help streamline that as well make sure you’re capturing every dollar that you possibly can.  And the third one is our Assign solution, which is around our automated patient assignment process. If you’re thinking about how you’re assigning patients manually, we’ve got an automated tool that takes a lot of the headache out of that. 

I put just a couple other things on the screen so you can see, we talked a little bit about some of the partners, Lisa mentioned a few of those EHR systems that we worked with, through some of the billing systems, things like that. So we’ve gotten pretty familiar with a lot of different tools that are out there. And we do a lot of direct integrations to help make this obviously as seamless and streamlined as possible. And then when it comes to some of those impact areas, what can you expect by streamlining your charge capture revenue process? It really comes down to increasing your revenue, improving your cash flow acceleration, and improving charge throughput and the productivity of that. So those are the key metrics that we see our customers look for. And we’re really happy to help in those three areas.    

I just want to thank you again for joining us today. Thank you Lisa and Malachi for sharing your knowledge on this topic. Like I said, we will be sending out a copy of the recording which you can circulate with anyone who you think might be interested. And we’ll be sharing more details around anything else that you might have questions about today if we weren’t able to get to them. So thank you again for your time today. And I hope everyone has a great afternoon. Thanks everyone. Thanks, guys.