Career Paths: Veteran access pro segues into revenue management

Computer and financial experience were key

Several years ago, when The Ohio State University Health System (OSUHS) decided to convert from its homegrown computer system to a commercial product, Joe Denney, CHAM, who was then director of patient access and financial services, was given a choice between two career options.

"My boss said, You can stay in the operational world and continue [managing] 24-7, or I will make you project lead for implementation of the new system,’" Denney recalls. "I decided it was time for a change."

That choice set Denney on a course of action that led ultimately to his current position as OSUHS’ director of revenue management. His experience overseeing the computer conversion and the knowledge gained from past positions have been invaluable in preparing him for his role in the organization’s innovative revenue cycle management effort, Denney explains.

"For the next year, I did nothing but cleaning up the conversion, the bad data, and fixing bugs," he says. "Having had patient access management and patient accounting experience before, I was the lead person in finding the cure for what ailed us. Within a year of when we went live with the new system, we bought a community hospital."

That hospital was found not to be Y2K-compliant, Denney adds, so his next mission became overseeing the purchase and installation of a new computer system for that facility.

"At that point, we had cleaned up a lot of stuff, and we started saying, Where do we want to be headed to make sure we’re handling accounts receivable in the most efficient way — collecting cash, getting claims out quickly, doing cleaner and cleaner registrations? Fairly quickly, the whole idea of access and revenue cycle management began to evolve."

Although there had been much finger pointing at access departments by business offices over the years, he says, no one had taken seriously enough the idea that if you fix what’s wrong on the front end, you fix a lot of the problem.

"We were not unique," Denney says. "Others all around the country started saying, Maybe if we got the registration process down better, got precerts, we would solve the clean-claim problem without billers having to touch the account."

Think in terms of patient management

Part of the reason the issue came to light, he suggests, was that many hospitals were buying new computer systems or enhancements in preparation for Y2K. "We started thinking in terms of patient management, and there was more of an emphasis on feeding clean data, and you can only feed clean data if you collect clean data."

At his facility, meanwhile, as Denney was "cleaning up the goofs and data errors involved in computer conversion," it became apparent that the charge description masters (CDM) had not been serviced properly, he adds. "There had never been that kind of attention placed on them."

In addition, the federal government was about to implement the outpatient prospective payment system (OPPS), and the correct coding initiative was coming into play, Denney points out.

"There was more emphasis on compliance," he continues, "so people started saying, We have to get this whole middle piece right, too.’"

About that time, the person at OSUHS who, among other things, had been responsible for the charge master, decided to leave the organization to become a consultant, Denney notes. It became clear to hospital leadership, he says, that handling the charge master should be more than a piece of someone’s job. It called for a person and probably a team.

"I was made director of revenue management at that point, and I quickly was able to document the need for a staff," he says. "I justified one full-time equivalent to start with and — with OPPS requiring procedure-based billing in the emergency department by August 2000 — quickly justified another. Within a year, we had a third."

With Denney, those three staff members make up what is called the CDM team, he adds. "We have liaison function between 200-plus cost centers and [responsibility to] compliantly bill every hard-coded CPT [current procedural terminology] and procedure that comes out of the charge description master."

Operational background key

His experience in access management, where he dealt directly with patient care units and ancillary services on a daily basis, has been of great benefit in his current position, Denney says, as has his financial knowledge.

"Given that background, I know the priorities of the people who are out there providing services," he notes, "but I also know, from the financial perspective, that it doesn’t do any good to provide service if you’re not getting paid for it."

Because he sees both sides of the coin, Denney adds, he asks the question, "How can I go out there and — without disrupting patient care — work with them to see if we can capture more charges?"

The subject of charge capture compliance, he notes, is gaining the attention of the industry. "You wouldn’t believe the number of consultants out there who want to help."