Lowell General Hospital Boosts Revenue Cycle Performance with Trace
Lowell General is a community hospital of approximately 400 beds serving the greater Lowell, Massachusetts region, about 30 miles outside of Boston. Prior to implementing the Trace® platform from Vyne Medical, Lowell General managed revenue cycle activities through a predominately manual, paper-based process. Not only was the process inefficient, but it left teams without proof of their exchanges when needed.
Lowell General partnered with Vyne Medical for implementation of Trace in 2011. Since then, the hospital has leveraged the suite of voice, fax and image tools to streamline and support revenue cycle processes in departments such as the Patient Access Call Center, Patient Financial Services and Patient Accounting. In each of these areas, teams capture and index activities to the patient account, creating a digital audit trail of revenue cycle communications.
Physician Order Management
Before Trace, Lowell General’s approach to physician order management involved receiving paper faxes, making copies and then delivering them to the appropriate service areas. Orders were often misfiled to the incorrect date of service or misplaced altogether. Lost orders resulted in service delays, rescheduling and cancellations – all of which caused considerable dissatisfaction among patients, physicians and office staff.
“It all led to wasted time, wasted money, and unhappy patients and physicians, not to mention frustrated employees,” said William Wyman, vice president of Revenue Services. “We needed assurance that when we received something it was going to the appropriate area. We also needed to streamline the effort so it wasn’t all manual.”
With Trace, Lowell General receives orders through an electronic queue. Orders are indexed to the patient account and filtered by department so that each area can access its own faxes. Faxes are no longer misdirected but are immediately accessible when patients arrive for service, reducing unnecessary delays. As a result, Lowell General has seen a rise in customer service and physician satisfaction. In fact, the hospital’s Press Ganey scores for physician satisfaction increased from the 40th to the 90th percentile between 2011 and 2012.
Overall, the process has helped to alleviate administrative burden, reduce expenses, improve service efficiency, and boost financial performance. Lowell has experienced an increase in employee productivity by maintaining staffing levels despite increasing call volumes, in large part because staff no longer waste time leaving their desks to search for paperwork. The hospital also decreased paper consumption by 40 percent.
When Lowell General implemented Trace, the hospital was losing approximately $900,000 in gross revenues per year due to notification denials for inpatient admissions. According to Wyman, insurance companies often stated by phone that services did not require preauthorization and later rejected the claims based on lack of authorization. Even when the hospital produced lengthy notes referencing prior conversations and attempted appeals, payers continued to deny the claims.
Lowell General now leverages proof of its recorded exchanges with payers to help prevent and overturn denials, streamline appeals and reduce payment delays. Today, the hospital loses less than $75,000 in gross revenues per year due to inpatient notification denials, representing a 92 percent improvement.
“That’s because Trace brings undeniable proof that we did what we needed to do to get paid,” said Wyman. “We did everything right, and now we can prove it to the payers.”
In the area of pre-certifications alone, the amount of revenue lost to denied claims plummeted from $250,000 a month to just $5,000 a month, improving the hospital’s net reimbursement by nearly $3 million a year. Through these and other revenue cycle improvements, accounts receivable (AR) days dropped, falling 16 percent from 42 days to 35 days between 2011 and 2012.
Lowell General has leveraged Trace to facilitate improved revenue cycle performance through the following accomplishments:
- Increased efficiency by automating manual, paper-based processes
- Improved patient and physician satisfaction through streamlined order process
- Elevated revenues through reduced denials and AR days with documentation of payer communication
- Enhanced customer service with improved quality assurance