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Adventist Health System

Clinically-driven revenue cycle nets cleaner claims for Adventist Health System

In two years, one of the largest non-profit health systems in the U.S. saw its clean claims rate climb ten percent. It credits that, in no small part, to its comprehensive and clinically-driven revenue cycle solution.

In 2013, Adventist Health System (AHS) began the initial rollout of Cerner Patient Accounting to its 45 hospital facilities and nine Central Billing Offices (CBOs) across ten states.

To date, 14 hospitals and five CBOs are live. In addition to a better clean claims rate, all of those facilities have, on average, maintained their cash collections before, during and after go-live.

AHS credits two key differentiators for its clean claims success.

First and foremost, “it allows you to do and see so many things – it’s much more flexible and powerful,” states Ken Ursin, AHS Corporate Director of Patient Financial Services.

Before transitioning to Cerner Patient Accounting, AHS’ legacy system was configured to pull data from 25 disparate databases and only allowed for encounter-level views and transactions. Today, data is consolidated and integrated across only three databases and CBO staff can see and manage accounts receivable data in different views (at the charge, claim, encounter, or account level) and / or perspectives (patient, provider, payer, etc.).

Better access to the data, said Ursin, allows AHS financial and clinical staff to see and understand how their particular role contributes to AHS revenue cycle processes and operations.

Ursin praises the added transparency as the other major differentiator. “Ultimately,” he said “everything is now reportable and trackable. Nothing is hidden.”

It also increases staff accountability and streamlines previous manual issue tracking and mitigation processes, which were previously done via spreadsheets, emails and phone calls.

“I can see if there is $25,000.00 in claims being held that require additional charge documentation,” said Ursin. “I can also see who specifically – maybe it’s three different nurses – those charges are attributed to. That is big pick up for us.”

That transparency, paired with the seamless integration of clinical and financial data, embeds a series of checks and balances within the clinician and CBO workflows.

Cerner Patient Accounting talks to the physicians and the nurses, telling them that they missed this charge. They learn very quickly to document it right the first time,” Ursin says.

As a result, clinicians are improving their clinical documentation. Better documentation not only helps generate better clinical outcomes, but helps ensure that claims are cleaner before they make it to the CBO staff for posting.

With continued implementations planned in 2016 and 2017, AHS is excited to see continued clinical and financial improvements.

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.