It’s All About the Network: How Two Hospital Groups Overcame Financial Challenges With athenahealth’s Unique Solution
Too many hospital-affiliated and -owned practices struggle with outdated, fragile billing systems and processes. They also encounter major headaches due to the installation and maintenance across multiple practice sites.
In addition, many hospitals are focusing on how to manage and grow their organizations. For many, there is no consistent platform across all practices that would allow them to get a holistic view of the organization. Worse yet, for those that do have a system it’s over a decade old. As a result, managing the physician organization is nearly impossible – there’s no ability to manage or monitor. Any hope of effectively expanding the physician organization is further hampered by bottlenecks associated with old technology.
It doesn’t have to be this way. Following are two client success stories highlighting large, complex medical groups running practices across several sites. Find out how they used our unique network-based approach to smooth practice workflow, increase billing transparency, and improve their bottom line.
“athenahealth is built the way you want it to be”
Within moments of meeting athenahealth’s co-founder Todd Park, Tammy Shepherd, the chief financial officer for Medical Administrative Services at The University of Kansas Medical Center, felt athenahealth’s unique web-based services would be a good fit.
“athenahealth is built the way you want it to be,” Shepherd said. “Other systems are old and outdated. We add new features from other vendors every so often but the other systems really pale in comparison to athenahealth which is updating its rules and features all the time.”
Less than a year after meeting Todd, the physician practices owned by the University of Kansas Hospital went live. Currently, over 70 KU Medical doctors and providers are billing on the system, which is helping to enforce best practices and provide accountability across the organization.
Similarly, Centra Health, based in Lynchburg, Virginia, selected athenahealth after looking at more than 100 practice management vendors. They were confident athenahealth would help them automate and streamline its online patient scheduling, registration, claims processing and collections for its growing healthcare enterprise. Centra also felt athenahealth would give them the necessary assets for designing and establishing new practice strategies as well as reconstructing physician and payer performance.
“We were forced to manually track all claims”
Before athenahealth, Centra Health’s in-house practice management system was incapable of serving its expanding needs. The system provided inaccurate and unreliable patient reports that were dramatically lowering Centra’s accounts receivable cycle. In fact, the health system’s days in accounts receivable (DAR) was significantly above the industry average at a staggering 151 days.
On top of that, Centra Health’s internal revenue cycle system was not automated and therefore required users to track all transactions on their own. “We were forced to manually track all claims that had been submitted and we were seeing that because many of the patient reports contained incorrect information, the claims were not getting processed,” said Tammy H. Tweedy, RN, Director of Centra Health Professional Services. “In many instances, the operation was unaware of this fact because the current system did not possess an automatic alert mechanism. In the end, we ran into many situations where we ended up having to take a loss,” said Tweedy.
Likewise, the KU Medical staff was in the dark when it came to tracking vital information. “Before athenahealth, our claims would drop and we wouldn’t know why,” Shepherd said. “We would find out 60 days into the process and then have to start over. Now, we see why the claims are dropping and which particular employee caused the error. It keeps the staff on their toes. Nothing is lost in the shuffle anymore.”
DAR drops, cash flow increases
athenahealth’s proprietary rules engine houses the largest collection of real-time payer rules in the industry. So staff at each practice in the system can catch and correct billing errors before they become problems.
For example, athenahealth’s Rules Engine provided users at KU Medical with the appropriate insurer codes and rules, and has considerably reduced the average claim’s days in accounts receivable (DAR). Before athenahealth, a cardiology claim would usually spend roughly 65 days in accounts receivable. But now, thanks to the athenahealth staff’s monitoring of every claim’s progress the DAR has dropped to roughly 35 days.
“We have eight specialties billing with athenahealth,” Shepherd said. “Every single entity has seen a significant drop in days in accounts receivable.”
Centra Health also experienced a systematic reduction in claims processing errors, a significant drop in the number of denied claims, an accelerated accounts receivable cycle and dramatically reduced claims processing costs. Centra Health has dropped its DAR from 151 days on average to 49 days, a 68% decrease in DAR.
Unprecedented transparency
With athenahealth, it’s easier to see when the mistakes are made. Administrators are more accountable for their claims because the system can pinpoint missing slips and incorrect information in a claim. If an insurance number or billing code is entered incorrectly, athenahealth flags the error and immediately identifies why the claim will not drop clean.
Centra Health now has the ability to easily submit and monitor the status of all claims throughout the enterprise. With athenahealth’s “hold buckets” feature, the staff is automatically notified as to which claims were not going to get processed by a payer and why, after which they were able to fix the errors in a timely fashion. Through this transparency into the billing process, Centra could identify trends and patterns that helped generate clean claims the first time around, something not possible with the previous system.
Seamless implementation
athenaCollector is a web-based platform that seamlessly connects the hospital with owned and affiliated practices. What’s more: the solution is web-based, so you can access the system anywhere with a secured internet connection. There’s no need to buy new server hardware. No upfront licensing fees. No lengthy integration efforts.
In addition, athenahealth provides clients with an instant system upgrade about every six weeks and the staff is continually updating the rules engine as payer requirements change. Updates appear instantly in the work screen. There’s no re-installation, no new software. The staff sees the changes instantly, without jumping through any upgrade or implementation hoops.
Data for long-term growth
athenahealth’s easy-to-use, powerful reporting capabilities are a major plus for hospitals looking to improve and expand. Hospitals enjoy exceptional visibility into each of their practices with instant access to key performance data. This gives them an enormous edge in everything from negotiating payer contracts to realizing economies of scale within back office billing functions.
“Reports are accurate and timely. Everything is instantaneous,” said Tweedy. “I can get reports in three seconds as opposed to the past when I had to wait several hours for a report to generate, a report which, in many cases, wasn’t always accurate.”
Centra Health leveraged athenahealth services to expand dramatically over five years. For instance, in 2004, Centra Health leveraged athenahealth to create a Master Patient Index to interface with Centra's hospital registration system, resulting in massive operational and financial improvements across the health care system.
A unique relationship
The KU Medical staff provides direct feedback and suggestions to athenahealth on how the system can be improved.
“Almost all of the enhancements that we’ve asked for have made been done,” Shepherd said. “They really listen to their customers and appreciate the feedback.”
This kind of responsiveness to client requests stems from more than just a desire to keep clients happy. athenahealth is paid based on results—so the more revenue KU Medical brings in, the more athenahealth makes as a company. This means that if a client has an idea for improvements that will help the system improve their revenue or efficiency, it is in our immediate financial interest to make the change. Especially because an improvement to the system doesn’t just benefit one client; it benefits everyone using that functionality across the athenahealth client network.
The bottom line
“Over the years our partnership with athenahealth has enabled Centra Health to expand our operation, design new ambulatory strategies and empower us to manage what is now a sprawling regional care delivery system that touches all corners of the state,” said Tweedy. “Our MSO has grown from 20 doctors to 115 doctors in five years without an increase in support staff.”
We provide the tools, services and knowledge for all our clients to be as successful.