Improve jointly with clinical areas

To collaborate with clinical areas on quality improvement, Stacy Calvaruso, CHAM, assistant vice president of patient management at Ochsner Health System in New Orleans, assigns her staff members to projects involving both areas.

"These individuals cross-report to the various teams," Calvaruso says. "They will have the ability to influence the other team members, by obtaining buy-in on the value of the work performed from the other area."

In one recent project, the radiology oncology service line was reviewed by patient access and clinical managers. "We performed a cross-departmental review of the registration, discharge, billing, and account reconciliation process," says Calvaruso. "We found that there were many areas where we were performing the correct actions, but using different areas in our software system to document."

Using different areas caused problems in the billing area, for example, because they weren't able to view comments documented by registration.

Overall, Calvaruso says that the project "produced a collaborative working environment, all the way from leadership through line-level associates, in both the clinical and clerical environments." Productivity and operational efficiencies improved, resulting in increased collections and fewer denials, she says.

In the radiology oncology area, a service line expert position was created. This individual participates in group discussions with the leadership team to review denials, productivity, unbilled claims, and pending claims.

"This approach promotes a faster resolution time which speeds up claim processing," says Calvaruso. "It puts more responsibility on the clinical care team to participate in the financial outcomes of the services they provide."