Transitioning from outsourced billing program to in-house centralized billing program

Revenue cycle management and financial outcomes are tied directly to efficient information sharing between clinical and operational systems and financial systems. Having a clearly-defined process for sharing this information beginning before admission at pre-registration and following through to admission, treatment, discharge, and finally billing will provide the most successful results. A typical revenue cycle strategy for long-term care providers depends on clinical data flowing directly to billing and collections in the most efficient process.

ProviNET's Centralized Billing Program with multi-level planningThe monumental task of bringing the billing process to an in-house, centralized billing program requires multi-level planning across all disciplines and management structures within a multi-site organization. These changes in billing requirements and healthcare environments led one California-based provider to review their billing systems and to explore opportunities for increased efficiency and regulatory compliance for their five campuses. ProviNET’s initial Discovery process revealed procedures that did not support the changing regulations and the ongoing need to ensure accurate claims that reflect the clinical information needed to support the services reflected on the claims. The provider was outsourcing their billing, and staff was required to bridge the gap between the clinical information and the billing information. ProviNET immediately realized the need for efficient and comprehensive systems to ensure compliance with regulations and to improve the revenue cycle. Even though the five communities were different in the service offerings and number of residents being served, the billing processes could be structured to achieve similar results across those facilities.

ProviNET Solutions was asked to work with the organization to consolidate the billing process and assist with the development of clinical systems to improve compliance and accuracy across all disciplines. After initial planning, ProviNET’s consultants conducted an online evaluation of a select number of Minimum Data Sets (MDSs) to assess the types and amounts of services being provided. This also enabled us to assess the quality and completeness of the MDS sample.

ProviNET continued with a review of claims as the next step in the initial analysis process. Schedules were then set up at each facility to conduct on-site documentation reviews and staff interviews. On-site reviews provided the opportunity to look at community-level procedures and to appraise the documentation practices that ultimately drive and support billing. Each community had varying levels of electronic records, and the on-site reviews revealed the staff comfort level with an enhanced electronic health record. Additionally, the review of clinical documentation focused on compliance with State and Federal regulations. Onsite interviews with staff members including the business office staff, provided an objective analysis of job responsibilities and the cohesiveness of the interdisciplinary team.

ProviNET noted that the financial teams were not aware of the clinical process and there was minimum communication between the two groups. In some instances it was noted that detailed information regarding the resident condition and functional ability was not easily accessed or shared by the interdisciplinary team. This caused disconnects between the business office and informational resources needed to create claims. ProviNET’s comprehensive discovery processes provided our consultants with the information necessary to recommend next steps in the efforts to bring billing in-house and centralize the billing process. This process also included a review of any opportunities to expand the use of electronic healthcare records in the communities.

ProviNET was successful in assisting it’s customer through the process of bringing their billing in house, which led to more timely and accurate claims as well as a greater appreciation between the many clinical and operational staff and the finance team.

The project led to the ability of the IT staff at the organization to establish an ongoing implementation of the electronic medical record. ProviNET assisted in the introduction of Touch Screens, Clinical Notes and other electronic advancements.

Our goal is to deliver quality and cost-effective solutions, enabling you to dedicate your resources to providing excellent care and services. To learn more about transitioning from an outsourced billing program to an in-house centralized program, contact a ProviNET professional today.