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Spruced-Up Revenue Cycle Precedes Construction Plans

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By 2013, Physicians' Clinic of Iowa's five Cedar Rapids locations will move to a downtown PCI Medical Pavilion. The future pavilion has been described as a "state-of-the-art ambulatory care facility that will bring coordinated services together under one roof, creating an environment for collaboration that delivers better care and faster service."

Less obvious than new brick and mortar but also accomplished in a spirit of organization-wide collaboration are significant improvements in PCI’s revenue cycle management processes.

By implementing a combination of strategies, clinic and billing office staffs together have reduced their claim denial rate from 17 to 4.6 percent (3 percent for Midlands Choice claims).  They also reduced the clinic's average lag time between service and payment from 6-7 weeks to about 30 days.

These improvements occurred over a period of about two years, resulting from thorough commitment to what Eric Dalton, Senior Director of Administrative Services, calls "chipping away at the rock."

The strategies included:

  • Formal work groups, one for coding/reimbursement and another for issues related to patient registration;
  • Re-emphasis on the business office newsletter as a teaching tool and as a vehicle report on the work groups’ progress;
  • Weekly denial reports that, over time, show trends and help managers keep tabs on spikes, trends and opportunities for staff training;
  • Quarterly E&M audits to help ensure that coding matches the intensity of services that were provided and, when required, is accompanied by the necessary documentation; and
  • Identification of 10 “critical data elements” that must accompany new and updated patient registrations and weekly tracking of whether these data elements are being obtained.  Follow-up education is provided as needed.

Most importantly, bringing clinical staff, including physicians, and billing staff together resulted in success that neither could have accomplished separately.

“With consistency across the organization, we’re in a great position for moving forward,” Dalton said.