Pressure is mounting for hospitals to improve top-line revenue and bottom-line margins by implementing smarter, leaner work processes. Health First, Inc. sought a method to integrate disparate revenue processes for improved workflow and revenue management across its three-hospital system. The organization adopted web tracking technology to centralize key revenue-driving functions, expanding opportunities for data-sharing and workflow automation. Scheduling, pre-registration and authorization teams now electronically capture and index data for efficient retrieval, sorting and processing. The results are improved outcomes in productivity, cost containment and reimbursement.

Scheduling.
Physician orders and scheduling requests present a challenge to many hospitals. Manual, paper-driven processes place a strain on throughput, productivity and storage. Without a central intake area, orders are easily misplaced or sent to the wrong locations.

Health First, Inc. implemented a paperless process that routes all faxes through a central, web-based tracking system. Staff index orders by patient and notify appropriate clinical areas for service. By electronically routing faxes, Health First eliminated the need to request re-faxes of missing orders, improving physician satisfaction and streamlining patient throughput.

Spending less time on paperwork, staff improved productivity by 20 calls per day. This allowed associates to collect more information on the front-end prior to patient arrival. Calls are also recorded and indexed in the system to confirm that patients are scheduled correctly for requested procedures.

Pre-Registration.
Front-end staff often struggle to document efforts surrounding patient pre-registration. Information related to eligibility/benefits, medical necessity and financial responsibility are often filed in multiple work areas or misplaced all-together. As a result, staff spend valuable time looking for information or repeating tasks when records go missing. If a patient or physician later questions the accuracy of information, hospitals lack objective proof for their case.

At Health First, Inc., pre-registration activities are centralized at an off-site business center. The center applied the same web tracking technology to electronically capture and store pre-registration records. Phone calls, faxes and internet look-ups are digitally recorded, indexed by patient and archived in a searchable web database for retrieval system-wide. The center also records calls with patients for proof of out-of-pocket and procedure instructions.

By centralizing patient financial records, staff spend less time managing paperwork and more time with patients. Should information later be disputed, records provide evidence for immediate service recovery. Leaders also monitor records for quality assurance and training.

Precertification/Authorization.
Hospitals spend valuable resources working to notify and secure authorizations from payers. Authorization processes rely on decentralized tools including web, fax phone and email requests. If claims are later denied, evidence is difficult to find and often insufficient to defend against denials.

To level the playing field with payers, Health First, Inc. uses web tracking technology to document each step of the authorization process. Staff record, index and archive phone calls surrounding authorization. If a denial is issued, calls are replayed or transcribed as evidence of prior approval. For online verification, staff capture payer web screens showing benefits and eligibility at the time of service. Faxes and their transmission data also provide evidence of timely notification. All records are centralized in a single database, searchable by patient, date of service or other criteria.

Within four months of implementing this process, Health First, Inc. used records to overturn $400,000 in denials and prevent denials in excess of $900,000. In addition to reimbursement, the tracking system streamlined workflow by facilitating data-sharing and notification among departments. The front-end uses the technology to electronically notify the back-end of records, eliminating phone tag and paper processes. System monitoring and benchmarking also help ensure tasks are completed on time and appropriately for each patient.