See how AHI Software’s solutions have helped Riverside Healthcare System in Virginia optimize patient access.

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It has also lead to a reduction in the AR over 90 days from 38% to 20% this month! As bills go out cleaner, fewer get denied and therefore the collectors have fewer rejections/denials to work. The AR over 90 days dropped $8 million for us out of a total gross AR that runs around $98 million. We’ve collected more cash in 2005 with no more FTEs in a year in which the health system’s revenues and volumes were up. We are now looking to redeploy some of the collectors into other areas as they are not needed in insurance follow-up.

We have also been able to use the AHIQA accuracy percentages to form the basis of an incentive based pay system for the patient access staff. Average pay out was $123 for fourth quarter out of a possible $200. HR loves the quantitative method of determining the payout.

AHIQA has allowed us to move the QA process from the Verification Department to the front end. This has allowed Verifications to dedicate 3 FTE’s to the outpatient verification and patient financial obligation process, which has increased up-front collections and decreased denials due to lack of precertification.

The Verification Department is now working 70% more outpatient accounts prior to services being rendered. This Department is now also responsible for adding insurance information that is obtained after services are rendered which allows for more accuracy on the back end. They handle approximately 400 accounts a week through this process.

With the Verification Department handling the insurance referrals this has allowed Customer Service to focus on true patient mail rather than insurance related mail.

This took up most of their time. Other than new employee training, ongoing training and routine duties were pushed to the back burner.

The Patient Access Directors and Training Team began a search for an automated QA Business Partner and after viewing many products we selected AHI. Within 3 months we went live with our automated QA process.

We implemented the product in October 2005 and started out with QA scores in the 70’s and 80’s. Last month, January 2006, every facility made their 98% quality goal.

AHI delivered everything they promised. It is a user friendly service and our goals have been achieved.

We now benefit from 100% QA review. Productivity results are used for coaching and documenting employee performance records. Management has access to various reports for trending. The ‘real time’ functions of this product allows Management to review the number of registrations performed by the PA staff any time during the day. This is invaluable in coaching and, if needed, for discipline.

The PA staff knows their work is being monitored and they have taken ownership of their work performance, often checking their own scores and announcing when they have an ‘A’.

Aside from the benefits to the upfront side the Training Specialists have been able to return to their primary duties…training. They have been able to visit every facility and perform Intake Assessments, provide insurance training classes, all in addition to the routine new employee training.

Our employees participate in an Incentive Plan and quality is worth 75% of the payout with collections making up the other 25%. AHI QA provides indisputable reviews for this purpose.

Our objectives to provide clean data before the bill drops, improve workflow, positively impact cash inflow and reduce AR days are successful to date.

AHI’s Eligibility Verification provides automated, real time verification of the critical fields of a patient’s insurance eligibility data — such as name, SSN, policy number, etc. — so hospitals can quickly verify a patient’s insurance eligibility at the time of registration. The system automatically compares the data to all major payers and includes many of the regional and smaller payers as well.

“Our Eligibility Verification solution provides accurate verification of patients’ insurance eligibility at the beginning of the revenue cycle,” explained Tony Lopez, Vice President of AHI Software. “This verification results in reduced denials, fewer rejected claims and returned statements and a reduction of other delays that impede the collections process and slow the revenue cycle.”

In addition, the system automatically checks self pay registrations against Medicaid to identify potential coverage. Depending upon patient financial service policies, the co-pay, coinsurance and deductible information provided by many payers can be used at pre-registration or at registration to request payment or make arrangements for patients to satisfy their financial responsibilities.

Built to begin improving patient satisfaction by tracking patient progress from the moment of registration, AHI Lobby tracks and reduces patient wait times and time spent with registration staff until the process is complete to allow administrators to manage the lobby area more efficiently, monitor patient flow and improve customer satisfaction. Beginning with a paperless sign-in that ensures privacy compliance, the system tracks the amount of time patients spend in each department as they move through their entire care regimen.

Available in two versions — Professional and Enterprise — AHI Lobby uses a real-time dashboard to help management quickly identify the number of patients waiting in any registration area, allow staff reassignments as necessary and quickly adjust staff levels to facilitate workflow in all service areas and speed the delivery of service. The dashboard also shows where and on which activities all staff members are working along with the amount of time being spent on each activity.

“In addition to the real-time data sharing, enterprise-wide trending, performance data and savings in time and labor that AHI Lobby provides, the system can be extended beyond registration to track enterprise-wide patient flow,” explained Tony Lopez, Vice President of AHI Software. “Implementation of the Lobby system gives you everything you need to increase patient satisfaction, from the paperless sign in to easy-to-use reporting tools.”

The user-friendly reports of AHI Lobby allow for continuous trending of staff levels and constant evaluation and improvement of operational processes, allowing facilities to streamline workflow and thereby reduce patient complaints over extended wait times. The reports also offer data to highlight and ease bottlenecks in specific delivery service areas.

The hospital, located in Mount Airy, NC, had gone from checking all registrations to examining a percentage, and then back to doing a 100% review, she recounts. Much staff time was spent looking at registrations and sending them back to supervisors, then to representatives to be fixed and then back again, Hancock adds, and by that time, the bills had dropped.

Later, she notes, there were weekly training classes for registrars whose accuracy average dropped below a certain percentage. “We’d go over major errors and how to avoid them, without pointing out any one person, still trying to be very sensitive. What we finally understood is that with the number of pieces of information to know in a busy, busy outpatient area and an unpredictable emergency department, you can’t know them all.

“No one comes to work to make errors,” she adds. “Everyone comes prepared to do the best they can, and they still make errors. All of the encouragement and retraining in the world couldn’t stop these sometimes silly errors.”

Hancock, who worked in the airline industry for many years—most recently managing the customer complaint analysis area—says she knew from experience that there must be an automated means for the hospital system to gather and process its quality assurance information.

The airline representatives, she recalls, recorded all of the customer complaints in specific coded fields in a computer system, including “what, where, when, why codes; flights; dates; and city pairs” to define the actual customer concerns.

“We then used access queries, sequel logic and other systems to pull that information from those fields,” Hancock adds. “Being able to specify captured data fields is what enabled us to analyze and drilldown into massive amounts of information to create meaningful and actionable solutions.”

What the hospital needed, she realized, was a system that could measure fields, take them into another system and check for accuracy—that could scour through hundreds of registrations a week and find the errors that took up so much of the staff’s time.

“You can’t replace human intelligence, but with about 85% of the errors we had—tiny and big things—you could stop and at least make folks go back and look at them,” she says.

Before deciding on the error tracking tool the hospital ultimately chose, Hancock says, “we looked at four other systems that all had good points.” A couple were ruled out because they didn’t work in real-time, she adds, which meant that a relief employee who was on the job one day but not back again for a week couldn’t correct her errors in time to make a difference.

With a real-time system, employees could fix their errors and have the benefit of immediate feedback, Hancock notes. “What I wanted wasn’t a punitive grading system, but for these folks to come to work, give it their all and feel good at the end of the day about what they had done—and for the hospital to have clean billing [upfront] rather than fixing it on the back end.”

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Catholic Health East, based in Newtown Square, PA, is a multi-institutional Catholic health system, which is co-sponsored by 12 religious congregations, and Hope Ministries , a Public Juridic Person within Catholic Health East. The system includes 34 hospitals, which are located within 11 eastern states from Maine to Florida .

According to Cynthia D. Fry, Vice President of Revenue at CHE, “ensuring accuracy in the registration process is mutually beneficial for both patients and providers and the AHIQA solution helps CHE achieve this objective.”

According to Tony Lopez, Vice President, AHI Software, “We are pleased with the opportunity to work with the CHE team to provide our AHIQA solution to assist the CHE hospitals in improving data quality, administrative oversight, staff performance and productivity, resulting in revenue cycle success”

Riverside Health System, Newport News, Va., began using a manual registration audit process about two years ago. With this process, one FTE could perform only 20 registration audits per registrar per month, which were not enough to make statistically valid sample sizes. The health system averages more than 9,000 registrations per month. The registration staff did not believe the audits were valid because the sample was sometimes taken from one day, or they felt the audited registrations did not represent the overall quality of their work.

Given the time these audits took, claims typically had already been sent by patient accounting, making audit results useful only for education purposes. The revenue cycle management team was frustrated that manual efforts were not able to achieve the desired outcomes. A bolt-on software product that scrubbed the registration data quality was implemented in the health system’s three acute care facilities. Two months after implementation of the automated registration scrubber tool, the registrars fully embraced making their own corrections and learning
from their mistakes.

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