BoulderCentre rakes in pre-collections with revenue cycle acceleration tech
The BoulderCentre for Orthopedics & Spine is committed to providing patients with the highest level of care possible. Additionally, it is committed to improving the health care system and patient quality and experience in the state of Colorado.
THE PROBLEM
One challenge that threatened these goals was the process (or lack of a process) of collecting advance payments for surgeries and communicating estimates with patients in the modern ways common in other industries – such as email and SMS.
“Although we lacked an effective process, we had a full-time employee solely responsible for pre-collection,” said Sherri Lewis, director of revenue cycle management at BoulderCentre for Orthopedics & Spine. “The job required many manual steps and navigation through multiple portals and software. Due to the operational inefficiencies inherent in our technology, this employee was placing an average of five orders per day, according to our reports in Athenahealth.”
“To make matters worse, the advance collections collected by our office were never based on a contractual rate,” she explained. “The current procedural terminology codes were not cross-referenced with our payer’s contracted rates and subtracted from the deductible and coinsurance to obtain an accurate estimate. Ultimately this meant our process was very unstructured and tended to be inaccurate.”
SUGGESTION
When Lewis started at BoulderCentre, the CEO had purchased a revenue cycle acceleration platform called Rivet. She wanted something that was easy to use and also integrated with the Athena EHR.
“Unfortunately, when I first joined, the team had not yet adopted the technology, so my role was to step in and transition the team to optimized technology,” said Lewis. “I quickly realized that technology would help us rethink our back-office payments process to help our team find our money, or in other words, ‘Stop losing revenue.’
“Niet accomplishes this by, among other things, providing an accurate estimate for the patient, considering insurance benefits, the correct codes and BoulderCentre’s unique contract rates with payers to derive a good faith estimate,” she continued. “With a good faith estimate, we could effectively make it easier for our patients to pay up front.”
Additionally, Lewis learned that Rivet offers revenue reimbursement to make up for any underpayments by payers. Rivet would address all of the common payment challenges, and by simplifying accounts receivable on the back end, the healthcare organization would save both time and money, she added.
“As is often the case when learning a new technology, my team was initially hesitant to learn how to use it,” Lewis recalls. “They expected the new technology to create additional work, which couldn’t be further from the truth.
“Our leadership team communicated the value of the platform and how it would make their work easier by eliminating the manual element of the pre-collection process,” she continued. “Unlike our old process, Rivet’s team didn’t have to spend all day searching different portals and calling insurance companies.”
To drive adoption of the technology, employees emphasized that the team could maximize both productivity and revenue through automated workflows, she added.
STAND UP TO THE CHALLENGE
The revenue cycle acceleration platform is integrated directly into the Athena EHR platform, which was non-negotiable for Lewis when the team was initially looking for a platform to implement.
“When planning a surgery, an order is created in Athena by one of our medical assistants who has insight into our doctor’s surgical plan,” Lewis said. “Once the appointment is confirmed and the order is approved through pre-approval, it goes to our pre-collection agent.
“Once we have approval, the person in charge of pre-collection enters the information into Rivet to get an estimate,” she explained. “While this was once a cumbersome and manual process, it is now seamless and user-friendly. The estimate is sent via email and SMS to the patient, where they can pay directly via a secure link before services are provided.”
When scheduling the surgery, the medical assistant ensures the patient has the correct contact information and tells them to expect an estimate. Patients appreciate this level of proactivity and transparency about the cost of their medical care, Lewis said.
“Although patients receive their estimates immediately, they are not expected to pay immediately,” she noted. “Ideally we aim to collect the advance payment at least five days before the operation. The Athena integration simplifies the process of gently reminding patients to pay at this time, ensuring no payments are missed.”
Once an estimate is created, it is saved under a patient case in Athena. When a patient comes for a pre-operative appointment, the receptionist can print it out and give it to them. In Rivet there is a status feature that allows you to see whether a patient has received, opened or downloaded the estimate.
“This has been a helpful feature and gives the team a clear overview of where the patient is in the payment process to avoid difficult conversations,” Lewis explained. “Effective debt collection management is all about meeting expectations and over-communicating with patients.”
RESULTS
“From a financial perspective, implementing the platform has been and continues to be a huge win for BoulderCentre,” Lewis said. “Since we began using it in September 2022, we have completed 4,759 estimates, totaling up to $898,000 in advance recoveries. It is an extremely cost-effective tool in our practice that has paid for itself time and time again.”
“Patient AR on the backend has also improved significantly,” she continued. “We collect more and faster.”
From a workforce perspective, the revenue platform has increased efficiency so that just collecting and executing estimates is no longer a full-time job.
“While we previously had several people working on pre-surveys, the person we have on staff now has additional capacity to not only carry out all pre-surveys and estimates, but also pre-approvals and work for the MRI department said Lewis. “This staffing efficiency is invaluable in addressing the workforce shortages currently being felt across the healthcare industry.
“Although it is not as easy to quantify, we are hearing feedback from patients that they value this new payment method,” she noted. “When patients receive an estimate, it includes the CPT codes and diagnosis codes that are projected so patients can contact the surgery center for more information.”
Patients call with questions about their estimates, which staff welcomes because they want to see the estimates and understand their care process.
“The more educated patients are and the more information they have, the better,” Lewis said. “With this improved transparency and communication with our patients, we have built significant goodwill for our practice in the community.”
“While the value of satisfied, happy patients is less measurable, it cannot be overstated,” she continued. “These patients help bring the next patient through our doors.”
ADVICE FOR OTHERS
“If your company is looking to implement a revenue growth platform, it is imperative that your employees see the value of the technology so that they don’t resist the implementation,” advises Lewis. “New processes usually trigger resistance because of concerns about increased workflow.
“Make it clear to your team that the initial learning curve and training is worth the benefits the technology brings to the practice,” she said.
Practices are operating on tighter margins than ever before, so it is critical for practices of all sizes to ensure they are providing the best possible quality of care while maximizing revenue, she added.
“If practice staff have to spend three days manually collecting data when they could be using more automated workflows, the practice has lost its revenue buffer,” she concluded. “Using technology to maximize revenue and improve the patient experience will be critical to long-term success, especially as the economy continues to struggle.”
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