Pennsylvania Health System Anticipates Cash Acceleration, Cost Savings From New RCM Technology

When DuBois-based Pennsylvania Mountains Healthcare Alliance set out to select a technology platform to manage the system’s revenue cycle, the primary goal was to find an end-to-end solution that would support PMHA’s 13 community hospitals for years to come, Nicole Clauson said. vice president of finance and revenue cycle of Becker.

“Before, we had multiple vendors with different platforms that managed different pockets within a revenue cycle. They were separate databases that were not connected to each other,” she said.

Also, at the time, her team was doing a significant amount of manual reporting. “We had to gather information together to get the reports we wanted. We wanted to understand what was happening so we could identify issues and save time by automating revenue workflows,” said Ms Clauson.

The health system landed on FinThrive’s revenue management service, which brings together all parts of the revenue cycle into a central system. There are multiple levels of installation and training, so while all hospitals in the system will eventually be on board, Ms. Clauson said she is focusing on a slower, more strategic rollout.

On March 15, four hospitals began using the contract management portion of the platform, and one hospital launched the back-end claims management component.

of Becker spoke with Ms. Clawson about her expectations for the new technology in PMHA’s hospitals and the biggest current opportunities it will bring to PMHA. She also offered one piece of advice for her colleagues in hospital finance and revenue cycle management.

Editor’s note: Answers have been lightly edited for brevity and clarity.

Q: Why did you decide to centralize your revenue cycle management technology?

Nicole Clauson: We wanted to create efficiencies in revenue management, especially around cost reduction. When we started looking, we were focused on finding technology that would support us now and in five to 10 years. We already have trouble finding talent and we knew we had to find a way to become more efficient so we could use the people we have in the most optimal way.

Q: What capabilities does FinThrive’s platform offer your hospitals?

NC: We undertook an ad hoc project with one of FinThrive’s products, Insurance Discovery. We knew it had the potential to help us file our self-pay claims that were sitting there [not getting paid]. Perhaps these are claims where patients have notified us of the correct insurance. We were told we could run them through the system. Was I skeptical? Yes, when we signed up. But it has proven to be very effective and is part of the system that we will likely continue to use.

Also, the possibility of partnership is also important. When we were looking for a vendor, we didn’t just want to find a “supplier”. We wanted to choose a partner, a company that understood our model. FinThrive pushed those buttons.

Q: What are the toughest revenue cycle challenges you’re dealing with right now?

NC: After COVID, we are focused on restoring efficiency and standardization. Before COVID we were good at what we do, but now we need to refocus and rebuild those efficiencies and processes.

Q: Do you have any data to suggest that an end-to-end systems approach will create the efficiencies you’re talking about?

NC: Absolutely. Here’s an example: patients don’t always provide the right information when they walk in the door. This platform allows us to track data from the patient’s point of entry to the point of bill payment. When there’s a mistake, we don’t get paid. This system is able to help with insurance discovery and we get better returns from payers.

Another example is labor costs. This system will be key to automating tasks and helping our employees do their jobs better.

Also, we’re in budget season, and my catchphrase for fiscal 2024 is “revenue optimization.” We were in cleanup mode from COVID and now we need to optimize our revenue. I’m not saying we should get paid more than we deserve, but we shouldn’t be paid less either. We believe our new system will help us get paid accurately for the services we provide.

Q: What are the biggest opportunities for PMHA now that you have this new RCM technology?

NC: The biggest economic opportunity is monetary acceleration. With clean claims going out the door, they can come back as money faster.

We want to stay ahead of the changes as much as possible and [embracing] a culture of innovation will help us do this. We can make sure that we have clean data in the system so that we have a reduction in bounces. The key to this is getting the information out right. We also make sure that everyone has access to information on one central platform. And again, the ability to automate is big for us.

Q: The first phase of FinThrive’s platform is contract management; what are the other phases of installation?

NC: Phase two is the back-end billing and bounce analyzer workflow. A third phase is the front end, which focuses on patient eligibility and the patient rater. We are very methodical and strategic about implementation. We want to make sure we customize the system for our needs. This will make installations in other hospitals smoother and faster.

Q: Do you see any implementation challenges?

NC: Technology is only as good as the people using it. So we’re focused on making sure our staff have the training, tools and workflows to be able to use the system. We want to have the best results.

It is also important that both clinical staff and revenue staff can understand and access the system. We want clinicians to focus on patients, but as we have evolved in healthcare, they need to be accountable and informed so that they are paid for the services they provide.

Our goal is to ensure that the platform is understood by many different departments in the hospital.

Q: Are there technology trends in revenue cycle management that you are particularly excited about?

NC: I realize this is the unknown, but I am excited about how we will automate using AI and bots. For example, perhaps we can automate pre-service eligibility checks. In the backend, we can maybe use bots with collections. We can have a bot to monitor collection statuses and contact the payer to collect. This is not an attempt to eliminate staff, but it will help us make the best use of the staff we have in each hospital.

Q: What is your advice for a health system that has not upgraded to the RCM platform?

NC: Don’t hesitate.

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