Arizona ITWorks client experiences better efficiency in patient financial services department
Yavapai Regional Medical Center (YRMC), a Cerner ITWorks℠ client in Prescott, Arizona, had cumbersome operations in its patient financial services (PFS) department. Staff spent considerable time — nearly five hours a day — manually correcting claim denials. Today, YRMC reports substantial time savings and estimates it could save more than $93,790 in reduced claims processing costs for the 2017 fiscal year, thanks to an optimized process for 835 transactions.
Insurance payors use the 835 to make payments to health care providers, give explanations of benefits (EOBs), or both. When providers submit an 837 claim for services delivered, the 835 details the payment for that claim, including what charges were paid, reduced or denied, how they were paid, any bundling or splitting of claims, and whether there was a deductible, co-insurance or co-pay.
Previously, YRMC’s PFS department manually corrected posting errors from the 835s, despite having Cerner’s patient accounting solution since 2012. Knowing this was not sustainable, YRMC enlisted Cerner ITWorks to help optimize their process. They formed a weekly focus group to analyze their existing business practices and system design, where they uncovered unnecessary configuration that didn’t align with the way YRMC did business.
“Over the course of a month, we started seeing a reduction in work effort,” said Holly Baxter, a manager with Cerner ITWorks at YRMC. “Now every time a 835 posts, everyone feels more confident that the system is posting accurately.”
Cerner categorized YRMC’s 835 process by financial class to better understand the denial types that were being posted. They modified the patient accounting solution to be more closely aligned with Cerner’s Model Experience to help prevent certain errors from happening and then routed the denials types YRMC wanted to review to the patient accounting work queues. Additionally, Cerner educated the PFS department, going step-by-step through their workflows, to help them use the solution to its utmost potential.
Over the course of a few months, the teams formed a trusted relationship that enables the PFS department to work far more efficiently. Today, the 835 posting process is more accurate, saving four to five hours a day of corrective effort per person. Going forward, YRMC plans to more fully align with Cerner’s Model Experience for variance and denial workflows.
"What a great accomplishment!” said Raymond Merrill, YRMC’s Director of Patient Financial Services. “We have less touches, less manipulation of the remittances, more money posted and a much happier staff."