While clinical details of patient care are documented and accessible through the EHR, activity surrounding the revenue cycle does not always receive the same degree of documentation. Data collection occurs at every point of the patient encounter, beginning before the patient arrives at the hospital and continuing as providers work to coordinate care with physicians and insurance companies. 

Connecting Disconnected Data

Texas Health Resources has taken steps to aggregate patient data from disparate sources and form a comprehensive view of patient information exchanged across departments and entities. The process is designed to standardize best practices across the revenue cycle, ensuring consistency and improving system outcomes.

Texas Health implemented a technology platform to capture and integrate voice, fax and electronic exchanges that occur across the revenue cycle. Records are digitized and tied to the patient account for search, retrieval and sharing. Revenue cycle associates use the technology to record inbound and outbound phone calls with payers, physicians and patients. Associates record calls through a USB connection to their PCs and index recordings to criteria such as patient, physician, insurer and date of service.

Hospitals capture and digitize faxes from physicians and payers, as well as electronic exchanges from payer websites and ancillary systems. Once indexed, recordings and documents are searchable and retrievable for playback and viewing through a web-based portal. Records can also be automatically exported to the EHR and placed alongside the care record to form a more a complete view of available patient data.

Associates capture each step of the patient encounter, beginning with the faxed or electronic order from the physician. They record scheduling and pre-registration phone calls with patients, capturing important details such as demographics, procedure instructions and out-of-pocket estimates. Recordings are later referenced for quality assurance, data accuracy and issue resolution. Associates also document phone, fax and electronic communication with payers and reference records to prevent and overturn denials by providing proof of patient authorization.

On the day of service, registrars record in-person conversations with patients using small desktop microphones attached to their PCs. By comparing patient encounters prior to service with those that occur on the day of service, leaders can reduce unnecessary duplication and ensure the accuracy and consistency of information provided at each touch point. To conduct quality assurance of revenue cycle encounters, leaders use a web-based scoring module to generate online scorecards and track performance by agent, team and key measure.

Outcomes

Accountability: Texas Health has succeeded in building a culture of accountability around this process.

Hospitals provide leadership training and tools to impact metrics, including “call labs” where managers listen to revenue cycle interactions and learn from each other how to appropriately score agents in areas such as tone, empathy and adherence to scripting. The health system also conducts volume analysis to compare the number of recordings to the number of registrations and ensure that staff are recording consistently.

Patient Experience: By capturing each encounter and tying it to the patient account, Texas Health has established a more complete picture of the patient’s revenue cycle experience. Recordings—along with faxes and electronic documents associated to the patient—combine to form a digital audit trail of interactions from the initial encounter to admission. Centralized access permits authorized employees to retrieve records to clarify misunderstandings, provide training or conduct service recovery as needed. Over a three-year period, Texas Health raised its Press Ganey registration scores from the 40^th percentile to the 86^th percentile.

Security: An integrated platform provides a way for Texas Health to safely store and transfer revenue cycle data, protecting sensitive records while making information accessible to authorized viewers. A central point of access supports processes with tools to automatically and securely share records between systems and team members, tracking access points along the way. This has allowed the health system to eliminate paper—along with time consuming, error-prone processes—for greater efficiency, security and consistency across the revenue cycle. The process also reduced rework and back-and-forth between departments in search of patient information. By minimizing duplication and added paperwork on the day of service, one Texas Health hospital reduced patient time at registration from eight to five minutes and is now one of the system’s top Press Ganey performers.

Business Value: Documentation of revenue cycle encounters has given Texas Health valuable data to improve financial performance. Recordings of financial counseling conversations are used to train staff in requesting payment. Texas Health increased point of service collections by $7 million over a three-year period as a result. Recordings of payer authorizations are used to prevent and overturn denials, allowing the system to overturn $2.5 million in denials in one year alone.

Capturing and integrating disparate revenue cycle data to the EHR shows progress toward a patient record that is truly comprehensive and fully-accessible across the enterprise. Specifically, recording and integrating verbal exchanges gives hospitals the ability to leverage voice data in a way not previously possible.