How automation helps MidLantic Urology manage revenue cycles, prior authorizations

Automation tools have been a key part of boosting collections and managing finances at MidLantic Urology, controller Maryanne Thompson said.

MidLantic Urology has 10 ASCs across Pennsylvania; its latest center opened in Wayne in April.

Ms. Thompson told Becker's ASC Review about the systems she uses and why data is so important to the patient experience.

Note: Responses were edited for style.

Question: What are your center's strategies for maximizing collections?

Maryanne Thompson: Long-term sustainability requires financial executives, providers and billing teams to become more proactive in understanding and mitigating the financial risks in their practice. Trying to manually determine things like cash flow and overall financial health causes many practices to react to surface level problems instead of drawing on deeper insights to actually improve their revenue capture.

MidLantic Urology works with a third-party RCM solution that helps us get visibility into day-to- day processes and gauge performance through analytics and artificial intelligence-driven metrics and reports. This data also helps us improve our financial clearance and capitalize on patient-responsible balances. Additionally, at the start of the pandemic, Pennsylvania was one of the first states to lockdown, and many practices across the country had to quickly figure out how to manage a remote workforce. MedEvolve’s automation solution gave our management team visibility into staff productivity and the ability to communicate effectively as we all worked from home.

Retaining that workflow automation and data transparency has helped our multilocation group of more than 70 physicians maintain sound financial health this past year. Access to data ensures that we can proactively communicate and educate patients about their healthcare costs before rendering services. Our patients appreciate streamlined procedures that minimize the amount of time they spend waiting at the front desk and eliminate any billing surprises on the day of their appointment.

In short, having the right technological framework is key to our revenue cycle strategy, but it also provides significant return on investment in regard to patient experience. Having the data to create an open dialogue with our patients has been key to long-term sustainability in unstable times.

Q: What have been the biggest revenue cycle management challenges at your center? How are you addressing them?

MT: The ability to quickly mobilize our remote workforce was critical for maintaining a healthy bottom line and MidLantic’s workflow automation solution gave our administrators confidence they could seamlessly maintain control of billing activity, while optimizing communication and education.

Anywhere from 80 to 90 percent of claims don’t require immediate follow up, but many billing departments get bogged down with work that doesn’t have potential to produce near-term ROI. Without analytics, it is really challenging to prioritize workflows on a daily basis and know which patient responsible balances we can collect on. Having a clear view of how much money our practice has and when we can expect to collect on rendered services is foundational to maintaining a strong bottom line.

Powered by AI, our workflow automation tools are able to drill down into claims and provide immediate visibility into activities that had the most potential to generate revenue. This saves our staff from having to manually comb through hundreds of claims files, and instead immediately identify the best use of their time and assign tasks to improve overall team productivity. Workflow automation also helped us gain more insight into areas like accounts receivable, existing cash opportunity, accounts receivable status and more.

Q: How does your center manage prior authorization rules?

MT: In the first few months of the pandemic, many healthcare organizations were struggling — elective procedures were postponed, and communication with health plans was inconsistent as they were trying to figure out their own business. Getting prior authorizations and referrals for necessary therapies and injections was a daily challenge for MidLantic. Thankfully, we had a financial clearance solution in place that ensured billing staff were armed with all the information they needed in real-time (demographic/insurance/benefit information) to educate patients of their financial obligations and collect balances prior to rendering services. Our financial clearance solution also has an analytics and reporting function that helps billing staff identify the number of self-pay patients scheduled in a given month and prioritize collections up front with dashboards and reminders.

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