St. Joseph’s Health increased annual charges by $40M with new RCM tech

“A big contributing factor to this success was the creation of auto-text templates for common procedures, all pre-verified by coders to meet billing requirements,” said the health system’s CMIO.
St. Joseph's Health revenue cycle management RCM

Critical care building, St. Joseph’s University Medical Center, Paterson, New Jersey

When it came to revenue cycle management, St. Joseph’s Health, one of New Jersey’s largest safety net health systems, used to be very fragmented between ambulatory and acute care settings.

THE PROBLEM

Entering charges was done by hand, rather than through an automated process, with physicians having no visibility into the process. As a result, the care provided and the billing charges entered did not always match properly.

Fragmented tools and outdated processes left St. Joseph’s with challenges it needed to overcome to provide patients with the healthcare experience they desired. The health system also needed a connected system to help make it easier for its physicians to do their jobs and provide excellent care.

PROPOSAL

“Cerner’s revenue cycle solutions offered a solution for us to better connect our systems and automate previously manual work,” said Dr. Beth J. Kushner, chief medical information officer at St. Joseph’s Health. “We needed to be able to connect our whole system and create a clinically driven revenue cycle that is closely tied to care and documentation.”

Cerner also offered the opportunity for St. Joseph’s to more closely align with its physicians, the ones whose work and documentation are the primary source of revenue cycle input, she added. Cerner would help educate physicians on the importance of complete, accurate and detailed charting. In doing so, St. Joseph’s wanted to show physicians how their work directly affects revenue, she said.

MARKETPLACE

There are many vendors on the market with revenue cycle management technology solutions. Some of these vendors include Cerner, Conifer Health Solutions, Flywire, Guidehouse, nThrive, Patientco, RevSpring and VisitPay.

MEETING THE CHALLENGE

After St. Joseph’s transitioned to Cerner revenue cycle management, it was able to automate many of its previously manual processes and connect fragmented systems. It also was able to carry out computerized charge entry, creating quick-order pages for the most common charge codes that were customized for each specialty.

“We then conducted targeted education for the different specialties, showing examples of how to enter the most common procedures,” Kushner explained. “With the systems now connected, we were able to run reports to show the charges now match the procedures. This helped us ensure we were providing the most accurate information for our revenue cycle team.”

Shortly after St. Joseph’s migrated to the new revenue cycle management technology, it developed a cross-functional revenue cycle collaborative team that included physician leaders, as well as leaders from IT and billing.

“We recognized the need to closely align with physicians in order to be successful, working with Cerner to educate them on each step of the revenue cycle process to understand how components of medical documentation contribute to billing,” Kushner noted.

RESULTS

Using Cerner clinical and revenue cycle management solutions to help improve charge capture, correct fragmented processes and educate providers, St. Joseph’s increased charges by $39.6 million, or 19.7%, from 2018 to 2019.

“A big contributing factor to this success was the creation of auto-text templates for common procedures, all pre-verified by coders to meet billing requirements,” Kushner said. “Additional auto-text entries helped verify the work was correct, a requirement for proper billing.”

The revenue cycle management technology also has eligibility-checking functionality built in, helping staff determine if insurance will cover a patient’s care before scheduling an appointment. In addition to streamlining scheduling, this improves the healthcare experience by helping staff speak with patients beforehand to let them know their copay and other potential charges, she added.

ADVICE FOR OTHERS

“Before implementing a new revenue cycle, organizations should do a thorough analysis of the current holes in their system in order to focus on areas with increased need,” Kushner advised. “Organizations also need to establish key performance metrics early on and review them regularly.

“New solutions and systems only are successful with collaboration across the entire organization. Leaders need to facilitate a collaborative approach between physicians and revenue cycle teams to achieve great results. When physicians are empowered with proper education and understand how their work impacts revenue, the organization will be more closely aligned.”

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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