How Yale New Haven Health handles the RCM challenge keeping CFOs up at night: 2 expert insights

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Jennifer Amiri, profits cycle system analyst for Yale New Haven Health: “I wish to talk to you quickly about our technical construct for enhanced claim status. As a company, we chose to go with the X12277 file format for an improved claim status setup. Due to the fact that this file format simply appeared to work better for us as a company and what we were trying to do, that was. As Mark mentioned previously, we split the classification and status code combinations into 3 main groupings– informative, deferrable and actionable– and we connected each of these groups to a designated code in Epic that would allow us to route the accounts to be appropriate work queues to be worked by personnel.

We went live with Experians claims statusing in January of 2018. When we went live, we decided to develop a committee for this job with revenue cycle operational supervisors, follow-up experts, our system experts, and also assist from Experian.

At Yale New Haven (Conn.) Health, leaders are resolving this substantial challenge and driving revenue cycle performance with a method called improved claims statusing. Here are 2 essential insights shared during the discussion with Mr. Stucker, gently edited for clearness:.

Identifying and prioritizing rejections is among the most significant discomfort points for health systems today, according to Rob Stucker, senior vice president of revenue cycle management at Experian Health.

Angie Stewart –
Wednesday, October 28th, 2020
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” At the beginning of the process, we labeled everything as informational, which indicated we didnt have any unique routing rules in place. The accounts just followed their normal workflows. This enabled us to see the details that was being pulled into Epic and how we would have the ability to gain access to it and use it. It also offered us the chance to run reports on our claims to see which statuses were being utilized by which payers. Its probably no surprise to hear that not all payers used the very same status codes or that some codes are not being used as they were intended. This is why it was vital for us to be able to figure out which of our payers are using which status codes and what their intents were for those codes. This was the work done by the committee.”.

We went live with Experians claims statusing in January of 2018. We desired a systematic method to find statuses of our claims at the payer. Jennifer Amiri, earnings cycle system analyst for Yale New Haven Health: “I want to talk to you quickly about our technical develop for improved claim status. As an organization, we chose to go with the X12277 file format for a boosted claim status setup. It likewise offered us the opportunity to run reports on our claims to see which statuses were being used by which payers.

” Our committee had three objectives in mind when looking at claim statusing. We desired a methodical way to discover statuses of our claims at the payer. We wished to know [not just] did they receive them, but [] are they in process to turn down or pay? Will the payer pend for extra information? Are they set to reject? We were likewise looking for a method to eliminate the transactional, or non-added worth, work from our personnel. We believed by getting rid of the volume, we might enable staff to focus their efforts on the issue accounts that need real follow up. This would aid with increasing our payment speed– taking a proactive approach, remedying claim rejections or rejections prior to the remit is posted will allow us to get paid quicker. “.

” When we ask Directors or cfos or VPs, What keeps you up at night? one of the subjects that is normally No. 1 on the list is with regard to dealing with denials … so that youre investing your time on whats going to give you the biggest impact,” Mr. Stucker said throughout an Oct. 22 webinar sponsored by Experian Health and hosted by Beckers Hospital Review.

Click on this link to view a recording of the webinar.