Every year, hospitals repeatedly miss out on millions of dollars in complex claims reimbursement. Opportunities can be missed for a plethora of reasons, the primary ones being weaker processes due to the specialization complex claims require and denials because complicated state guidelines are not followed. All EnableComp clients benefit from the complex claim expertise provided by our services and our key processes that subsequently capture additional complex claims dollars regularly missed out by hospitals or non-specialized RCM partners.
Our team at EC has defined three key steps to a sound partnership implementation process:
- Define specific goals for success and make sure we are aligning our teams to carry out those specific procedures
- Secure the appropriate leaders within each organization to manage the project together to reduce the burden for the provider once live
- Tackle roadblocks early and quickly to prevent issues, so we can be sure the most efficient processes have been created ultimately leading to success for the provider and partner
If you want a successful implementation, start with understanding what processes are already in place. During this initial phase, the partner assures services can integrate into the hospital’s workflow seamlessly. Developing an implementation guideline document through the due diligence process is an essential tool that must be managed and distributed on a weekly basis, even if there are minor changes. This phase is also used to review current reports being utilized and determine what data can be tweaked to quicken the implementation process for straightforward financial reporting for the hospital. With a thoughtful pre-implementation plan, you can be assured that a plan exists to eliminate billing downtime leading to a smooth Accounts Receivable transition.
The second key to building a successful implementation plan is to identify the leader within each party who can best navigate his/her organization and can find answers quickly and efficiently. Each leader must assemble a team to be present for weekly conference calls and updates on project tasks. The EnableComp leader typically manages the implementation project plan and updates the requirements document on a weekly basis so the entire implementation group can use it for their weekly assignments and due dates. By providing extreme transparency between partners, having open discussions about the pros and cons of workflow choices, and working together to continually reinforce the overall goals of the partnership, success is virtually guaranteed! Both leaders must make it their priority to confirm that all approved procedures are ready to implement so that no penny is left on the table.
Thirdly, every implementation will have its major decision points that require group input. The key to eliminating barriers is tackling them head on vs. addressing later in the project. Getting off track during implementation is easy to do, so it’s critical to evaluate the unique processes and requirements and identify which ones are critical to the success of the partnership. For example, vendors are asked to implement a process required by a hospital that may not be the ideal internal workflow, but it is critical to certain claims reimbursement. Rather than rejecting the hospital’s request to make this step part of the vendor’s process, the team was able to discern the “why” for the requirement and craft an enhanced solution while still meeting the needs of the requirement. This becomes a win/win by working together as true partners by finding a method to capture maximum reimbursements while simultaneously removing perceived barriers to success. Throughout the implementation process, each organization runs into internal and external roadblocks, but hitting them head on will make sure that 100% of claims are appropriately processed for reimbursement, leading to minimal denials and allow the hospital to extract the best possible return on investment from the partner.
Working through these three key areas during implementation will ensure partnerships between hospitals and vendors are set up for the best possible outcomes, low-to-zero costs to the provider’s resources and allow you to maximize performance that your chosen partner can produce. Due diligence and questioning processes early, picking the appropriate implementation leaders and tackling roadblocks early and efficiently will capture the buy-in from both organizations to create a strong partnership, lead to seamless implementation and create the win for all. Now, go collect your millions.