ALN sought digital process improvements that would streamline operations and mitigate rising complexity and costs.
The organisation partnered with NTT DATA to optimise revenue cycle management workflows that improve productivity and operational efficiency.
“Working together, we’ve made tremendous progress identifying and pursuing areas for process improvement. Our clients care about costs. But they also care about quality. These improvements ensure that we can deliver on both.”
As the costs of healthcare delivery continue to rise, healthcare payers create ever more complex demands for processing claims. For example, claim denials issued by payers are frequent; they create costly rework, impeding revenue collection.
To address the demands put on them by payers, healthcare providers often outsource their claims processing to revenue cycle management (RCM) companies that specialise in managing claims and collecting revenue for patient services.
ALN Medical Management has been providing revenue cycle management services to independent physicians since 2001. The company’s goal is to maximise collections for its physician clients while providing them with actionable insights into their business.
Success demands accuracy and efficiency
ALN's Chief Information Officer, Eliot Payson, says, “Revenue cycle management is a highly competitive market. Our clients pay us a set fee to process a claim on their behalf. We don’t get paid to rework a claim, so our business success relies on processing claims accurately and as efficiently as possible. It’s critical that we strive to get the work done right the first time”.
ALN continuously evaluates its revenue cycle management workflows in pursuit of best practices. To that end, ALN has a long history of partnership with NTT DATA and its Business Process Outsourcing teams. Their journey together encompasses designing services and driving efficiencies in many RCM workflows including:
Centralised rules for accurate claims submission
A necessary first step to processing a claim – and eliminating rework – is to ensure that the claim is filed correctly for payment. That requires knowing and adhering to the often-nuanced rules dictated by each healthcare payer. Historically at ALN, that knowledge had been decentralised across the organisation. To optimise access to those rules, NTT DATA built a knowledge management system centralising the rules and their frequent updates that are used by both ALN and NTT DATA staff.
With the knowledge management system in place, ALN’s Vice President of Revenue Cycle Management, Jean Dowling, says, “When a payer changes a rule, we can note that in one place and confidently know that it's going to get communicated and implemented across the organisation so that team members can correctly process the claim. It’s a great database to help us keep our claims work moving forward”.
Denial posting simplified through automation
Managing claims denials is one of the biggest challenges an RCM provider faces, and ALN is no different. ALN and NTT DATA evaluated ALN’s workflow for denial posting and saw the opportunity to use automation to eliminate many of the manual steps required to post denials. The automation would also improve the accuracy of routing denials to appropriate teams within ALN and NTT DATA.
Automating the denial posting workflow significantly reduced the touch count per claim and thus resulted in faster and more accurate processing of denials. A typical result: in one month in which 40,000 denied CPTs were processed, 14,800 (37%) of those were fully automated with the remaining 25,200 (63%) requiring only one manual touch versus the six required before automation.
Optimised AR workflow
With the denial posting automation in place, ALN and NTT DATA attacked another bottleneck to further simplify and accelerate claims processing: this one in the AR workflow. At the time, tickets for AR claims were assigned to teams by the date on which they were last modified rather than by the skills required to resolve the tickets. By tagging each claim with denial and last visit owner categories, the claims could be routed to teams with the claims resolution skills relevant to those categories. Distributing claims to these pockets of excellence accelerated the turnaround time for AR tickets as well as increased the productivity and quality of the AR teams’ output.
ERA auto-posting review: transformed and fine-tuned
“Working together with NTT DATA, we identified a third area in which we felt we could significantly improve our workflows”, says Dowling. “We regularly managed hundreds of thousands of auto-posted ERA transactions per month for our clients. About 40% of those were incorrectly posted and our Centricity system had no way to identify them. Consequently, we had to validate every transaction manually, which was not only time consuming but also opened the door to error and rework.”
ALN and NTT DATA created a daily process whereby they map data from a bulk volume of ERA auto-posts into a spreadsheet. By applying payment posting concepts and comparison formulas that they have coded into the spreadsheet, ALN and NTT DATA can rapidly identify the incorrectly posted ERA transactions and fix them. This process reduced the number of manually reviewed ERA transactions from over 280,000 per month to less than 1,500 (a 99.5% reduction).
NTT DATA added one more refinements to the ERA auto-posting workflow. By identifying nearly 150 types of posting issues, they were able to further improve the identification of ERA exceptions and cut down that set of exceptions by another 50%.
Dowling says, “Day to day, those improvements in ERA exception handling have clearly made us much more efficient. That impact is even more important during our monthly financial close. Now we’re assured that we can process and balance our ERA payments in the time available”.
Streamlined for success
The streamlined workflows developed in partnership with NTT DATA further ALN’s ability to succeed in the complex and competitive RCM marketplace. “Working together, we’ve made tremendous progress identifying and pursuing areas for process improvement”, says Dowling. “Our clients care about costs. But they also care about quality. These improvements ensure that we can deliver on both.”