Kanawha County (West Virginia) Emergency Ambulance Authority (KCEAA) runs about 50,000 emergency responses and bills about a 100,000 responses a year throughout the region. We have a budget that everybody struggles with – especially at this time of year – as we start to come back into the next budget cycle. Several years ago, we made the switch to become a complete ZOLL shop using RescueNet Dispatch, ePCR and Billing. Why? We originally thought using different software vendors would prevent us from putting all of our eggs in one basket in the event of failures. The reality was that we spent a lot of time working on our system – managing upgrades and exchanges on various platforms – and not working on efficiencies for our billing department to help us get paid.
1. Eliminate Missed Opportunities to Get Paid
One of the most noticeable results of moving our software to the same platform: We are much more operationally, and therefore financially, efficient. Staff is expensive and wasted time is even more expensive. You couple that with the only time that a claim is actually working for you, and is valuable to you, is when it's not in your building. We believe that you have to have a claim that is correctly processed and submitted out to a payor, whoever that payor may be, as quickly as possible. And our goal is at zero day, which means that we would be billing the exact same day that the call was ran.
The reality today is we're at about 48 hours, which has a lot to do with when the call was ran, because billing doesn't typically work on weekends. The later in the week that we get, the closer to zero day we are. One of the big reasons we changed software is we struggled to make sure that every billable call was getting to our billing department. This was because we were running our CAD, ePCR and billing on multiple platforms. We started doing some of the math to see what our cost of doing business truly was. (I highly recommend every agency do this.) This is what we saw:
- If you lose one BLS emergency call (my rate’s about $317) a day, that's an excess of $114,000 per year that you're losing in revenue. As a result, we identified goals to eliminate all the areas where we were getting inaccuracies and where there were slowdowns.
- And this was even before the biller touched the claim the first time. Next, we looked at trip information that was being lost between the transfers from dispatch to ePCR to billing and determined what that value was. Turns out, we were losing about three calls a day on average, which also directly impacted our bottom line. What we want to do is present the biller with an absolute clean claim without having to go back and find the crew members to fill in any missing information.
- The last thing we looked at was how much time we were spending on our IP hardware and keeping the system up to date. For example, during a scheduled power outage, we sent our people home for the day, which equated to a day of lost production for our billing department. It cost us about $18,000 per hour.
2. Reduce Billing Lag Time
As a part of our journey to zero day billing, we wanted to reduce the time from when the crews finish a run and pass it along to our pre billing people to review the ePCR to when our billing department actually receives it. To help do this, when we switched over to ZOLL, their implementation team came in and helped us rework are workflows to better meet countrywide best practices. We also built better call rules that helped guide our field crews to collect all the information that they needed on particular call types. This was critical to the success of our billing department. This process is completed daily, and in many cases, is being completed before our crews go off duty. This training enabled us to streamline a lot of our processes and reduce our billing lag.
We hold a one-hour revenue cycle meeting once a week where we take an hour to make sure that we're on track with our goals to meet revenue and reimbursement numbers. The meeting includes operations, IT, administrative and training. We go over automated call reports and dive into any missing PCRs. For example, one missing PCR report detailed a call that was dispatched that didn’t have an end disposition (it was still on the medic’s tablet). It gave us the medic’s name so we could contact him/her to see if it was a failure of hardware or if perhaps they just didn’t do it. Additional automated reports show us trips for previous year to date so we can make comparisons. The meeting also provides a forum for the staff to stay informed on hanging situations with insurance companies, what their requirements are and so forth. Now, we’re happy to see that only three percent of PCRs have to go back to the field crews.
3. Decrease Keystrokes to Speed Up Revenue Cycle
Did you know that you save about 35 keystrokes per claim by not needing to leave your billing application to go to a clearinghouse to run an eligibility claim? Staying in application allows us to get on the right payor the first time.
One quarter last year we had 64 claims denied out of about 14,000. What killed me the most from that report were the claims that were denied because the patient couldn’t be identified, which was caused by bad billing information. It doesn’t matter if the bad information came from the hospital, the crew or if it was a keystroke air. The ability to check eligibility directly within RescueNet Billing has helped us reduce claim denials to where we are at about two denials out of 14,000 now. The feature tells us exactly where our claims are and where we need to focus our attention, enabling us to streamline the process and drop our denial rates to under one percent.
4. Leverage Reporting Tools to Improve Billing Production & Reduce DSO
The other piece is that because we can control the software better, we are now able to control metrics. Only the things that you monitor are actually ever improved, and we have gone to great lengths to be able to monitor production in the billing department.
For example, Cindy Wood, one of our employees in the billing department, puts charges on a claim during entry and queues it up to be sent out electronically. Our standard is that she needs to enter 15 of those per hour. I can pull up a report to see her production on any given day. Not only do my billing managers get this information, the admin staff as well as the billers get the report so they know where they stand against their quota. The reduction in manual work helps decrease our days sales outstanding (DSO) to ensure claims get paid faster. In fact, we were able to decrease our DSO days from 41 to 120.
5. Continually Refine Your Process to Increase Total Billing Department Efficiency
Keep making changes to your billing department so that you can take out steps that are unneeded, unwanted and only serve to slow your billing cycle down. We plan to continue to refine our approach. Once a year we sit down and process map every function in that in our billing department to see if there are steps that we can take out because something has changed.
For example, we only have 15 people in the department; and we made the decision to have them all work remotely. We have found that it’s best for our organization for our billers to work from home, because without distractions from the office, they focus their undivided attention on filing claims, which translates into more revenue for us. Another change we’ve made is creating positions for our staff to specialize in. We have three people who do Center for Medicare/Medicaid Services (CMS) appeals and approvals. They are experts in the most current Medicare requirements and know exactly what is necessary to complete those claims.
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