Thought Leadership

Case Study – A Revenue Cycle in Crisis

We were contacted by a large Community Mental Health organization in Kentucky because they were having some substantial issues with their revenue cycle process. They had gone live with a new Electronic Health Record (EHR) system and had been experiencing a lot of difficulties getting bills out the door. By the time we talked to them, they had millions of dollars of claims stuck in the system, and were also way behind in posting payments, finalizing their billing processes, and closing their books each month. As concerning to their leadership, they were unsure if they were actually billing, and being paid, for all of the services that they were providing. The staff felt like they were “wearing blinders” because they didn’t have the information or training to fix the problems, and were frozen as to what to do next.

Identifying the problem

Based on the number of issues that they were experiencing, we knew that we were going to have to start with a deep dive into the CMHs workflows, data capture methodology, and business processes to identify the root cause of the problems. To do this, we went to the source and began to meet with the billing and finance staff. During this phase of the project we worked together to identify where information was being captured, how the system was configured, and how the files were being processed. We created reports and extracted data to understand any data integrity issues that were causing systemic problems. Utilizing this information we were able to identify updates that needed to be made to both the system and the CMHs workflow to ensure that we could get their bills out the door and that the issues wouldn’t continue into the future. As we were working with staff, we also tried to understand their pain points, because it became apparent that they didn’t have any comfort with the functionality of the system.

Getting bills out the door

Once we felt comfortable that we used the available data to identify major issues, we began two parallel processes to get the CMH back on track. The first was an effort to update the system configuration that was causing problems, while coordinating with the vendor on updates that needed to be made to development that was completed during the implementation. This ensured that the system setup was in a place where the outputs and files would behave as expected throughout the charge creation, claim generation, and posting processes.

The second was the creation of a toolkit that the CMH would be able to utilize to monitor clinical and billing activity at early stages in the system workflow. This consisted of reports and system notifications that allowed the staff to be much more proactive, preventing issues that billing was having to clean up at later times. Along with this effort, we also helped to document the key processes so that the staff would have explicit guides to understand how the system worked and how to problem solve any issues that they ran into in the future. This combination empowered the staff, and also increased their efficiency and satisfaction with the workflow and functionality of the EHR.

Keeping up the momentum

After we were able to help the CMH get back to a good baseline, we wanted to make sure we kept them there. To do so, we setup a meeting every other week to discuss issues, review reports, and encourage the continued alignment to best practices and workflows that we defined throughout the engagement. After a short time providing this coaching, the CMH was comfortable using the tools and techniques that we created to manage the full revenue cycle moving forward. At that point we were able to extract ourselves knowing that they were in a place to continue providing their services without having to worry about their revenue cycle issues slowing them down.

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