Serving northwest Indiana, Community Healthcare System (CHS) is composed of three nonprofit hospitals: the 445-bed Community Hospital in Munster, the 191-bed St. Catherine Hospital in East Chicago and St. Mary Medical Center, a 195-bed facility in Hobart. Together, the hospitals make up the area's largest integrated healthcare system with 6,500 employees, 950 physicians and 124 allied health professionals.
CHS' Patient Financial Services department likes to focus on the positive. And one huge positive for the three-hospital system is the success rate of accurate patient registrations, which can speed the revenue cycle through fewer denials and rejected claims, as well as fewer returned statements.
Accurate billing starts with accurate information, making patient registration vital to the overall success of the claims process. CHS was looking for technical help to improve the quality of claims and to create their own rules
"We were looking for a solution to help us have clean claims," recalls Karen Schneider, Regional Director of Patient Financial Services, who has been with CHS since 1985. "We knew the registration process was becoming more and more complicated, so we wanted a way to help registration staff upfront and be able to apply our rules."
Ahi QA stood out from competitors because of the product’s flexibility to write edits that went beyond those that came with the product, and CHS installed the solution and a new claims system in 2008.
“We had a lot of claim edits that we used on the back end, but we were able to move them to the front end to prevent them from happening in the first place,” Schneider says.
The importance of registration accuracy comes from management, and Ahi QA scores are part of user evaluation and management evaluation. Schneider, the hospital CFOs, billing managers and others often send thank you notes or congratulatory signs to reinforce the importance of registration accuracy.
Due to the early success with Ahi QA, there was no question that Ahi QA would continue to be used when CHS chose Epic in 2010 as the electronic medical record system to replace the disparate electronic medical record (EMR) systems used at its three hospitals.
Because the changeover to a new EMR system is a huge undertaking, Monita Puckett, Ahi QA system administrator, says the registration staff at the first hospital switching to Epic in February 2011 did not have access to Ahi QA immediately. She quickly learned that the staff felt lost without its functionality to verify patient information, so Ahi QA was turned on at the same time the EMR went live at the other two hospitals. In addition to patient registration, CHS uses Ahi QA for address and identity verification, which has helped reduce returned mail and the potential to bill the wrong payer.
A Best Practice Committee consisting of managers and supervisors from patient accounting, registration, physician offices and central scheduling meets every six to eight weeks to discuss common tools, including Ahi QA. Schneider credits the committee for keeping the focus on the software and for proactively suggesting edits that make users' jobs easier
After installing Ahi QA, the changes brought the days in accounts receivable down by 25% to 42.9 days in 2010. When CHS installed its new EMR, accounts receivable days rose in the year following implementation, but they dropped again and were 46.45 days as of June 30, 2013.
Schneider credits the robust functionality of Ahi QA with helping to improve the first-time accuracy of registration information, which averaged more than 99.5% during the last six months of 2013 and was 99.69% in December 2013.
"We do require that all of our registration users maintain 99% accuracy or greater, but most users hit 100%," Schneider says. "We have consistently had 100% accuracy at St. Catherine Hospital since the very beginning, because of the diligence of the manager, Sandra Hill."
The phenomenal accuracy rates that registration and financial counselors have achieved can be credited to a solid combination of reasons – the usability of the software, a positive institutional attitude that focuses on accuracy instead of errors and executive buy-in.