| In what seems like only a few short years, fiscal | | | | accounts during outpatient tax income charge-capture |
| selective information systems (FIS) have evolved | | | | audits yielded Sir Thomas More than $10 a million in |
| from simple, back-office support systems into fully | | | | additional charges.Furthermore, monthly cash |
| integrated solutions that can handle everything from | | | | collections for 2004 exceeded those for 2003 by |
| payroll to accounts receivable and gross cycle | | | | $10.4 , while net taxation between 2001 and 2003 |
| management. But such increased functionality would | | | | increased by $44 as a result of improvements in |
| not be possible without the ability to combine | | | | charge capture, coding, reduced bad debt and |
| disparate databases into a single source of entropy | | | | incremental tax revenue recovery. In addition, |
| that can be mined at multiple levels.The importance | | | | operating profitability, during that same period, |
| of data mining quickly became apparent to corporate | | | | improved by $40 . A focus on reversing the losses |
| executives at James Edmund Scripps Wellness in San | | | | incurred during 2000 and 2001 also led to establish a |
| Diego, who had been working with six separate | | | | systemwide cycle steering committee, as well as |
| databases before upgrading to a newer variant of | | | | multidisciplinary teams on the level so that |
| Dawn Approach Coach/Affected role Fiscal Handler | | | | "everybody would be on the same page,".Drake adds |
| from Boca Raton, Fla.-founded Eclipsys Corp.Edward | | | | that coordinating the steering committee and teams |
| Wyllis Scripps currently operates five acute care | | | | helped define how the centralized business office |
| facilities totaling nearly 1,400 beds, two medical | | | | could best support the needs of each facility. Those |
| groups with 14 outpatient clinics, a home health | | | | weekly meetings covered a wide range of topics, |
| agency and a health plan. Today, yearly revenues | | | | she says, including coverage, interim and obstacles to |
| average $1.35 billion, which is a big turnaround from a | | | | discharge. But went even further in overhauling its |
| few years ago when posted operating losses in 2000 | | | | strategies.It developed a -dedicated claims processing |
| and 2001 totaling approximately $26 1000000 and $22 | | | | team within Kaiser's regional claims center in |
| one thousand thousand and respectively. In an effort | | | | Pasadena, Calif., which reduced the claims backlog by |
| to bolster their bottom line, devised a number of key | | | | $6. It outsourced unpaid commercial and PPO |
| strategies, not the least of which was drastically | | | | outpatient claims to QuadraMed. "We wanted our |
| changing their methods of charge and | | | | people to stay focused on higher-dollar claims," |
| reimbursement."A couple of years ago we moved | | | | explains . Drake also says, "We did an awful lot of |
| away from capitated risk to fee-for-service risk," | | | | work on appeals by working with our payers and |
| says David Ferdinand Julius Cohn, vice president of | | | | improving our contracts."There's no question that |
| patient services. Additionally, since each infirmary had | | | | upgrading to Dawning Memory access Director |
| been running its own Eclipsys FIS, the organization | | | | Patient role Managing director variation 11.3 improved |
| made the decision to rise these 13--old systems by | | | | the organization's efficiency in accessing and analyzing |
| installing an enterprisewide FIS.Realized similar gains in | | | | data. A major driver in that rising slope was the EDI |
| efficiencies, although not all were directly related to | | | | transaction set requirements mandated by HIPAA, |
| the adoption of a new software solution. admits that | | | | says.Also, needed to streamline its Medicare process, |
| a significant portion of gain was due to process | | | | since Medicare accounts for about 35 percent to 40 |
| improvements in recovering underpayments from | | | | percent of its business. Due to time constraints |
| third-party payers."We look at trends by types of | | | | resulting from the HIPAA deadline, was unable to |
| underpayments and develop strategies to work | | | | install a Web- edition of the Eclipsys software, |
| together with our payer partners," he says, adding | | | | choosing instead the character- interpretation that |
| that collection of underpayments in financial 2003 was | | | | could ruin on a UNIX platform using a cache system, |
| 9 percent above 2002, amounting to More than $15.4 | | | | says Drake. However, plans are already in the works |
| meg. The auditing of Thomas More than 100,000 | | | | to ascent to reading 11.4. |