An occasional upgrade to the registration system used to be the only reason the paths of IT and revenue cycle leaders ever crossed.
“The old legacy registration and billing systems really didn’t touch anything else. IT would just turn it on; there wasn’t that much to it,” recalls Jon Neikirk, executive director of the revenue cycle at Froedtert Health in Milwaukee.
That has changed dramatically. Revenue cycle leaders and IT need one another to thrive. “Today’s registration systems are all very integrated, with organizations trying to push the envelope and offer more self-service and a better patient experience,” Neikirk notes.
Until recently, an Epic analyst was stationed within the revenue cycle department. “We were very involved from an IT standpoint,” Neikirk says. “It allowed us to do a lot of things that we otherwise would not have been able to.”
The situation ended recently. With the analyst now stationed in the IT department, “it’s made things a bit more challenging,” Neikirk says.
But after spending time with IT in close proximity, revenue cycle leaders gained a great deal of expertise. This comes in handy in bridging the gap between the two areas. “Our registration leaders have had to work really hard to get some familiarity amongst the teams,” Neikirk says. “You’ve got to put the time in, and keep regular communication going.” Revenue cycle leaders invited IT leaders to come see how employees register patients. “There’s good collaboration at this point,” Neikirk reports. There were a few recent revenue cycle initiatives that succeeded because of good relationships with IT:
• Patients who want appointments sooner can go on a wait list. Previously, it required time-consuming calls with a scheduler. Patients hated it, and schedulers spent a great deal of time on it. Now, if an appointment slot opens, an email or text is sent to the patient with an offer for the spot. If the patient clicks “yes,” it is scheduled automatically, and the previous appointment is cancelled.
• Some patients receive estimates automatically. “One of our goals is to estimate out-of-pocket costs, for both hospital and physician charges, prior to their visit,” Neikirk says.
For several years, the department offered price estimates, but patients had to request them. Now, estimates are produced automatically for imaging. At the time it is scheduled, staff tell the patient to keep an eye out for the estimate.
• The process of obtaining authorizations is beginning to become automated. “We’ve got a lot of FTEs working in the prior authorization department,” Neikirk observes.
A lot of time is spent on lengthy phone calls with payers. The goal is for some authorization requests to be sent electronically, with a response coming back from the payer. “We are rolling it out one payer at a time,” Neikirk explains.
The department started with United Healthcare, their largest payer. If things go smoothly, the next two largest payers, Anthem and Humana, will be next. For now, at least, only imaging authorizations are automated. Generally, these are less complex than other types of authorization requests, and, usually, no peer-to-peer review is required.
• The department recently implemented patient self-scheduling. Patients can book primary care visits online. “That’s been a huge win. Our patients love it,” Neikirk says.
Revenue cycle leaders maintain a long list of projects they want to complete right away. Many expect IT to drop everything else to handle it. “We’re not always going to be first,” Neikirk admits. “Every department is saying the same thing — ‘There’s a new shiny object out there, turn it on.’”
Sometimes, the hospital CEO asks IT to focus all its efforts on a single initiative. “There are multiple priorities that IT is juggling that aren’t necessarily what the registration department thinks is the right priority,” Neikirk laments. “We’ve got to be OK with that.”
The health system’s steering committee, not the revenue cycle, ultimately decides what IT works on. Still, a “squeaky wheel” strategy pays off. But just making demands without any research to back it up is not going to be effective. “As a revenue cycle leader, you can’t just expect that IT will anticipate your needs,” Neikirk notes.
Simply saying, “We’ve got to have this functionality. It’s going to make our lives so much easier” is not going to cut it. Tying the IT request to an organizationwide priority is much better. Patient safety, the patient experience, or more revenue all are good bets. “If you come and say, ‘I can save 10 FTEs by doing this,’ it will go higher on the list,” Neikirk says.
IT is not going to go out of its way to educate revenue cycle areas on all the exciting new developments coming soon. Revenue cycle leaders can learn by attending vendor-sponsored user groups. “If you look at the list of presentations, it’s not IT directors giving them, it’s registration directors,” Neikirk observes. Participating in these kinds of events can answer loads of questions: What kind of results can the revenue cycle achieve? What is coming next? This kind of insider knowledge, combined with some patience, goes a long way. “We can then have a better conversation with our IT counterparts,” Neikirk says.