Most Wired

The Unshowy Charms of Back-Office IT

By Douglas Page

Cutting-edge billing and process systems may not be glamorous, but their assets are undeniable

Most attention to hospital information systems these days centers on clinical schemes like computerized provider order entry and PACS that improve physician efficiency and patient safety. Back-office IT may be the homely stepchild, but automated accounting, claims, submission and supply management systems are being implemented in growing numbers for a simple reason—they help keep bottom lines in the black.

Computer systems that automate the capture of files not only result in faster, more accurate posting to patient accounting or practice management systems, they also save users up to 80 percent on costs over traditional paper processing. Providers get paid faster when information moves electronically. Users also can be confident that all claims are processed in compliance with HIPAA mandates.

At the University of Pittsburgh Medical Center, the entire supply requisition-to-order process is electronic, going directly from the end user's desktop to the vendor with no involvement from supply chain staff. "We estimate that this procurement automation is saving UPMC more than $3 million annually and giving time back to nurses and physicians for patient care instead of ordering, tracking or looking for supplies," says Chief Supply Chain Officer Jim Szilagy.

University of Iowa Hospitals and Clinics implemented automated revenue cycle tools to capture billing information more accurately and closer to the source to minimize claim denials. "By reducing denials, we accelerate payment of services and therefore improve cash flows," says Chief Information Officer Lee Carmen.

The University of California, San Diego Medical Center uses numerous tools in its revenue cycle administration and patient financial services areas to bolster revenue capture. "By careful integration of our registration and scheduling systems, and verifying financial clearance before the delivery of service, we ensure that front-end eligibility, benefits determination and authorization are passed seamlessly to our back-end billing products, reducing denials and maximizing capture," says Chief Medical Information Officer Joshua Lee, M.D. UCSD added on third-party products to its registration and scheduling tools so staff can track patient clearance up front.

Health systems that acquire new hospitals often find IT systems aren't standardized. When a hospital recently joined Main Line Health, Bryn Mawr, Pa., one of the first tasks was to migrate the new facility's general financial, human resources, patient management and accounting systems over to Main Line's common platform. "This standardized our systems, our practices and our reporting across all of Main Line member hospitals and has allowed us to reduce the costs of maintaining duplicate systems," says Vice President and CIO Karen Thomas.

Standardization streamlines administrative processes. "Our enterprise resource planning optimization project has reduced month-end financial close by five days, " says Mark Moroses, CIO of Continuum Health Partners, New York.

Before its current project to install an automated practice management system, Community Health Network, Indianapolis, had about 500 providers at 150 locations billing out of 111 different databases. The new system gets CHN to a single-billing platform for its employed physician offices. Chief Technology Officer Rick Copple estimates the overall benefit to CHN's bottom line will be an additional $4 million to $7 million in revenue annually.

Boston's Beth Israel Deaconess Medical Center simplified administrative chores by affiliating with the New England Healthcare Exchange Network, which "lets us connect our registration and billing systems directly to health plan systems to make sure we are paid for services delivered," says CIO John Halamka, M.D. BIDMC uses NEHEN to verify insurance eligibility and co-pays, pre-authorize referrals, submit claims, check on referrals and claims to resolve billing issues and receive electronic payments. "It also gives us tools to monitor our revenue cycle and other administrative processes without adding armies of billing clerks," he says. "It even reduces our risk around cash reserves and ultimately, we believe, around malpractice, though that's yet to be quantified."

Douglas Page is a writer in Pine Mountain, Calif.

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