February, 2016:

Implementing a New System or Upgrading your Existing One? Are your Goals SMART?

Director Of Consulting Services

Director Of Consulting Services

Whenever any organization decides to implement a new system or upgrade their existing system there are typically goals they are trying to achieve. Sometimes those goals are addressing specific issues, adding functionality, or meeting the expectations of the organization.

How many times have you seen where goals are identified at the beginning of the project and yet no one ever circles back to determine if those goals were met at the end of the project?  Most often this happens when the organization’s goals were not SMART goals.

For those of you whom do not recall what a SMART goal is, let’s take a look back. The “S” in SMART stands for specific. Are you goals specific enough to be definite at the end of the project? For example, an organization’s goal to reduce patient check in time is not specific enough, what is included in the check in process?  Therefore defining this goal to include those specifics can provide clarity later. So our goal turns into “reduce patient check in time to include providing the patient with necessary paperwork, completing patient update in system, and marking patient arrived”.

The “M” stands for measureable. Is your goal measureable? Take for our patient access goal, further defining the goal to include “reduce patient check in time to include providing the patient with necessary paperwork, completing patient update in system, and marking patient arrived by 20%”, now gives the team a figure to measure when determining success. Therefore if the average check-in time was 5 minutes, the goal to reach is 4 minutes or less, on average, per patient.

The “A” stands for attainable. When setting goals at the beginning of the project we need to ensure that the goal can be obtain. Setting unrealistic expectations or figures that are not attainable may not demonstrate the success of your project. This is where the “R” in SMART comes in as well. Be realistic when setting your goals. Let’s go back to our goal above, what if we had set this goal to decrease the average check in time by 50%? Setting such a lofty goal for your team members may be defeating before they even begin and unattainable.

Finally, the “T” stands for timely. Don’t set goals too far out. Ensure that your specific, measurable, attainable, realistic goal is set within a time frame that makes most sense to determine if the project was a success.



Automation of the Revenue Cycle


Jill Berger-Fiffy , MHA, FACMPE Senior Consultant

Jill Berger-Fiffy , MHA, FACMPE
Senior Consultant

Are you optimizing technology and ensuring your revenue cycle is efficient? With rising costs and decreasing revenues, automation is no longer an option.   Advantages to automation include; decreasing manual and duplicative work, decreasing cost, improving data collection, improving cash flow, decreasing claim rejections and increasing cost savings.  Some areas to review are as follows:

Confirming patient’s eligibility before every visit is no longer optional.  Practice Management systems can automate and “batch” this feature; some can “run” the eligibility the same day, but prior to opening the office.   Consider how far in advance of the visit this information is required and if more than one attempt is needed.  If new patients are scheduled in less than a week, set the eligibility feature to activate during this time frame. By running the eligibility feature overnight but the same day as the visit, employees can prioritize their work and focus on the patients scheduled the same day.

Utilize insurance and other websites to confirm if valid referrals are available for upcoming scheduled visits. Train staff to confirm if the referral is on file, from the PCP of record and the correct date range. Create a central repository of the guidelines by payer. This prevents one staff person having all of the knowledge. Identify a uniformed location in the registration screen to add instructions for check in staff; such as “inform patient referrals expire on xx date or scan insurance card or annual paperwork required.”

Claims Submission using electronic remission (ERA) and posting via electronic fund transfer (EFT) are common in today’s billing office.  Daily processing ensures the practice is submitting to payers regularly.  This creates a smooth and continuous flow of payments in the practice.   Electronic fund transfers are reduce effort to process the payment and decrease the time the days in A/R thus improving the metrics of the practice.   The lockbox is another tool to reduce manual payment posting.  Ensure payments are being deposited into the lockbox rather than being sent to the office.

With health plans using their own software to identify potential denials to the practice, practices need to look for opportunities to circumvent denials. Practice Management systems and aftermarket products can have “rules based language” added as an overlay to the billing system and reduce or eliminate potential denials which need to be re-worked, resubmitted or revised.   The claim submission process can include a clearinghouse with a “scrubber” to clean the claims and further eliminate potential errors such as coding, demographics, missing referral, incorrect eligibility.   Denial summaries can be developed into a scorecard for staff and performance can be documented at the department and individual level.

Secure messaging between specialists and primary care physicians is a built in feature in many electronic health records.  This feature allows the transmission of patient information in a secure and immediate manner.  Secure messaging makes it easier for primary care physician and specialists to communicate clinical information and can enhance the referral process.  Secure messaging can reduce and/or eliminates the manual work involved in printing, copying and scanning and allows both practices to receive credit for the meaningful use transition of care measure.


Patient Portals are a tool to meet the patient engagement measure for Meaningful Use Stage 1 and 2 and enhance the relationship with patients.  Portals can be expanded to allow patients to ask questions about their care, download information about their visit and/or diagnosis, pay their bill, ask a question, and/or request a refill.  This feature can reduce no shows in your practice, and allow patient needs to be met, without a face to face contact.  Practices should have defined rules and workflows to ensure that patients with acute or chronic conditions receive the appropriate amount of face to face care at recommended intervals.

Reporting for Meaningful Use and PQRS will be required to negate revenue reductions. There are several methods including the GPRO, Registry and Individual reporting for PQRS.  Regardless of your metrics or specialty, it will be essential to have decision support tools and data extraction capability.  Speak with your EMR vendor to be sure you have this capability and know how to use it.

Use of telephonic Call confirmation is another meaningful use measure. Electronic call confirmation provides a record of the response of the patient when the call was received and/or numbers which were incorrect.  The program typically has an automatic dialer allowing several outreaches to the patient.  With the cost being as low as .10 cents, it is no longer effective to employ a staff member for this function.

The passive act of sending a statement does not always translate to a paid bill in the high deductible patient environment created by cost sharing models. Many patients do not understand how their plans work and the amount of out of pocket expense which is the first step to a paid claim.   Go green!  Consider the use of Estatements and/or possibly outsourced statements.   Reinvest the savings into hiring billing staff to reach out to patients, set up payment plans, explain their bill and associated deductibles and coinsurances and be a resource to the staff.

On line bill pay and secure storing of credit card numbers; go hand in hand with time of service estimates.  Be ready to provide patients with their expected patient responsibility when asked.  Utilize tools such as “credit card” on file to save the credit card numbers in a secure manner and set them to automate payment to the practice. On-line bill pay is a “no brainer’ as it allows patient to pay for their services 24 hours a day 365 days a year and reduces manual efforts of your staff.

Automation is a key component of a patient centered; cost effective and healthy revenue cycle. Assess the potential opportunities in your practice.







Patient Access, Patient Centered Care & Population Health-Let’s Connect the Dots

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IT Consolidation To Improve Revenue Cycle Performance

A multi-entity health system consisting of physician practice offices and ambulatory surgery centers was structured as multiple corporations working together to serve their patient population. Each organization maintained a separate database for revenue cycle operations.  This required multiple patient accounts for any surgical services provided, an account in the professional practice and one or more accounts when services were performed in the ambulatory surgery centers.  This resulted in complicated workflow for schedulers, check-in staff, charge entry staff and revenue cycle staff.  Additionally, reporting on total organizational activity required consolidation of data from multiple reports.


An analysis and work plan to consolidate the databases into a single, multi-entity database was performed. The practice management system in use supported multi-department, multi-entity with security features to segregate access and data as needed.


The professional services database was selected as the surviving database and was modified to accept and process the facility services of the ambulatory surgery centers. The changes implemented were to:

  • Utilize a new hierarchy level to separate the professional services from the facility services.
  • Establish the security settings to segregate data access between the entities to assure accurate billing in the consolidated environment.
  • Create the facility based claim formats (837i and UB04), as needed, to meet requirements for the carriers contracted that utilize these different formats.
  • Train staff impacted by these changes on the new workflows to take advantage of the new set up.
  • Establish a communication plan for the transitional period for patients with services spanning the transition as they would receive multiple bills from the ambulatory surgery centers for services based on date of service.


The effective date for the transition would be the beginning of the new fiscal year for the health system to provide the cleanest transition for reporting purposes.  This allowed for the impact of the transition and continued reporting from multiple databases to be isolated to a single year.


Improvement in business operations, patient and staff satisfaction was a direct result of this consolidation effort.

Randy Shulkin-picture

Do I Really Need an Oil Change? The Benefits of Ongoing Maintenance with you Car and Healthcare Technology


Have you ever asked yourself if you really need to perform an oil change in your car? Why do you need an oil change anyway? Well the oil lubricates the engine and carries heat away from your engine. There are thousands of engine components that work together in order to keep your car running, the oil lubricates these components. If we don’t get an oil change as recommended the oil becomes ineffective over time. That all makes sense right? Something we have all accepted and understand is a crucial part of keeping our vehicles running.

What does this have to do with health care technology?  Imagine the oil is the technology knowledge of your end users. As we all know work-arounds in the system occur from one office to the next and from one end user to the next end user. Are you one of those few organizations who conduct continuing education on the technology you have implemented? If not, liken that continuing education to the ongoing maintenance of your vehicle.

Now let’s imagine the oil is the application, such as your electronic health record or practice management system. Whenever an organization first implements their EHR or PM they are doing so with limited knowledge of what the application is capable of. Sometimes it is simply because decisions had to be made initially that limited the use of the system. Very few organizations have had the time or resources to dedicate to any amount of time towards system utilization and optimization. However now that we have meaningful use and ICD10 behind us we have reached the time where it is a great opportunity to take a step back and enhance the efficiencies of the system. Ongoing maintenance of the system is just as important as it is with the end users.

Whenever technology plays such a large role, as it does in health care these days, our priorities should include ongoing maintenance


Going to the Medical Mall: A Patient Retention Strategy

Culbert’s Johanna Epstein discusses going to the Medical Mall as a patient retention strategyMIR_3944-Johanna Epstein

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