- When you ask a provider which EHR system he uses, you expect to hear a single vendor, such as Epic, Cerner, or MEDITECH. But when you inquire about a provider’s revenue cycle management system, you are likely to get a laundry list of vendors and products for each component of the cycle.
Nearly 69 percent of healthcare organizations use more than one vendor solution for revenue cycle management, according to a recent HIMSS Analytics and Dimensional Insight survey.
The majority of organizations (71 percent) use their EHR system in conjunction with other revenue cycle management solutions. And most of these hospitals and practices partner with three or more vendors to manage their bottom line.
But even providers who do not use their EHR system for revenue cycle management reported engaging with multiple vendor solutions. Eleven percent of respondents use three or more vendor solutions and 4.3 percent use two separate systems.
The healthcare revenue cycle involves many moving parts, from patient registration and claim submission to patient accounting and account resolution. However different each step in the revenue cycle is, though, provider organizations need to ensure the cycle flows smoothly to collect timely reimbursement and patient payments.
Engaging with multiple vendors and systems to seamlessly manage the healthcare revenue cycle didn’t cut it for CGH Medical Center in northwest Illinois.
The acute care facility with 16 medical centers under its umbrella faced revenue cycle inefficiencies and errors by relying on a legacy system for patient accounting and Cerner for its EHR and other revenue cycle management systems.
“We were maintaining two separate chargemasters,” CGH Medical Center’s Director of Revenue Cycle Ken Koerner recently explained to RevCycleIntelligence.com. “It was hard because everything that you either added, changed, or deleted in one chargemaster, we had to do the same in the other chargemaster to keep them in sync. We had to run audits to ensure things weren't missed.”
“It created more opportunities for us to make mistakes,” he emphasized.
Other hospitals using multiple vendor solutions for revenue cycle management also report a decline in financial performance. About 69 percent of hospitals and health systems using three or more vendors have denial issues, and 67 percent of organizations report revenue integrity issues because of a lack of interoperability between different vendor solutions, the HIMSS Analytics and Dimensional Insight survey uncovered.
In addition to impacting CGH Medical Center’s bottom line, their legacy patient accounting system was also nearing the end of its life. CGH Medical Center had been using the solution since 1997 and the organization had customized the system to accommodate its professional and hospital billing needs.
However, only a few other hospitals in the nation were using the legacy patient accounting system by 2015. Koerner and his team feared that support for the tool would dwindle, leaving them with a revenue cycle management tool that would not be updated to reflect the ever-changing healthcare landscape.
It was a good time to move to a new, integrated product, Koerner stated.
Integrating revenue cycle management
CGH Medical Center ultimately decided on a new patient accounting system that integrated not only with the organization’s other revenue cycle management tools, but also its EHR system.
“We are a Cerner facility for everything except the billing system. We had implemented Cerner scheduling and registration and the Cerner clinicals in 2004,” Koerner explained. Now was the time to add the patient accounting component to their Cerner suite.
“We've been watching Cerner and their revenue cycle product to see how it matured, developed, and stabilized over the course of time,” he said. “We made the decision about three years ago to re-visit it. We did a formal RFP [request for proposal] process for it. We did site visits to look at facilities that were using it and to try to get some lessons learned.”
“We made the decision then that it was stable enough for us to go to it so that we could get rid of the interface and just have an integrated product,” he continued.
Ensuring revenue cycle management products fit with an organization’s EHR system is crucial for many provider organizations. A 2016 KLAS survey found that 59 percent of provider organizations considered a revenue system management replacement because they wanted more EHR and revenue cycle management integration.
“If you’re an Epic shop and Epic’s offering you revenue cycle management that is totally tied in and integrated with the clinical workflow, why would somebody buy anything else?” Mark Weber, Infor’s Senior Vice President of Healthcare Development, asked RevCycleIntelligence.com in 2017.
Koerner posited a similar question to himself and his team when he began searching for an integrated patient accounting and billing system. With the medical center already relying on Cerner for many of its clinical and financial processes, adding the patient accounting might help Koerner integrate data and reduce workflow redundancies and errors.
And CGH Medical Center did see significant improvements after integrating their patient accounting system under one vendor.
“The charge entry is much more integrated with our clinical areas now since we're all within the same Cerner product. There're just a number of advantages to having that integration,” he stated. “The initial big advantage was sharing all the information upstream with our access and scheduling departments regarding health plan employers, authorizations, and balance.”
The integrated system allowed the medical center to share scheduling and registration data upstream, which was impossible under the legacy patient accounting system. The medical center could also now change health plans, change employers, and share patient balance information upstream.
“We couldn't do any of those functions before,” he said. “And for the ones we could do, we had to physically log out and manually do those in the different products.”
As a result, revenue cycle management staff relied on just one chargemaster, instead of two.
“We've already improved our clean claim rate,” he continued. “That was an immediate win. We didn't have the ability in the other system to do as many customized claim edit rules prior to the bill dropping to our claim scrubber. We moved quite a bit of claim rules upstream and we've already improved that.”
Streamlining revenue cycle workflows and reducing preventable errors resulted in a major boost in revenue for the medical center. Revenue in the first two months went up, especially with improved charge capture and revenue integrity processes in place through the integrated system.
“Across the board on our KPIs that we track, our cash was better the first two months than it was the prior twelve-month average. Across the board we've seen an improvement in our metrics,” he emphasized.
Overcoming the challenges of integration
A key contributor to CGH Medical Center’s financial success after revenue cycle management integration was the help of a third-party, Koerner stressed.
“When we did our site visits prior to signing our contract for Cerner patient accounting, the lesson learned from everybody was that they wished they would've had a third party involved from the beginning to work with us,” he explained.
“We knew going in we wanted to do that so we engaged S&P Consultants. They actually did our optimization phase for us.”
The consulting firm also came in handy when the major health IT vendor proposed to halt the medical center’s revenue cycle management integration project.
“We got a couple months into our project and Cerner came to us and said they didn't have the resources to support us with our project moving forward and that was happening across the country at that time,” he said. “They were going to pause our project. At that time, we did not want to pause it.”
Revenue cycle management can be a challenge for major health IT companies that are primarily known for their EHR systems.
For example, the most recent patient accounting report from KLAS found that over one-half of Cerner’s Millennium EMR customers have yet to implement the company’s patient accounting solution “often due to functionality concerns and uncertainty as to whether the product can drive a healthy revenue cycle.”
But organizations who integrated Cerner’s patient accounting and clinical systems are still seeing some financial improvement, with one-third of organizations surveyed saying they met their financial goals after go-live, and about one-half saying they are on their way to achieving their targets.
These organizations are reaping the benefits of revenue cycle management integration by pursuing a different implementation road map, KLAS stressed. While a significant portion of the surveyed organizations anticipate Cerner to improve their revenue cycle management offerings and support, many are taking internal measures to ensure success.
Partnering with a third-party expert, like CGH Medical Center did, can help to ensure vendor roadblocks and bumps do not interfere with the integration process. Falling back on a consulting firm when vendor support was lacking helped the medical center to truly reap the financial rewards of integrating their revenue cycle management solutions.