Swedish Covenant Hospital Is a leading independent hospital in Chicago which includes more than 500 primary care physicians and specialists within the hospital, and over 150 providers within the Swedish Covenant Medical Group. This award-winning hospital has served the community for more than 130 years, delivering world-class care with compassion.
Many medical practices and physicians’ groups encounter challenges with their billing. Whether they’re doing it in-house and simply don’t have the resources or knowledge to set up the processes in a way that will lead to timely collections and claims processing, or they’re working with a third-party company doing the bare minimum, they find they have a system that doesn’t quite meet their needs. Solid billing practices, and the technology to execute, are key to a medical group’s financial health, so it’s important to identify the best way to address these challenges.
The Client’s Need
For many years, Swedish Covenant Hospital had been working with a third-party billing company for Swedish Medical Group’s billing. The process didn’t allow for adequate oversight and management of the billing, and there was a need to improve performance and efficiencies in this area. To achieve these goals, Swedish leadership made the decision to bring the Medical Group billing in house, and implement a revenue cycle management system to improve its financial performance.
Leadership recognized that they did not have the in-house expertise to define billing processes or design and implement a complete billing system setup.
“The Curas team was instrumental in driving the success of not only our transition to in-house billing, but also in helping us meet our goals for first pass claim rate more quickly than we ever thought possible. Their knowledge of eClinicalWorks®, medical billing workflow, and the claims process helped deliver the best possible outcomes for this project.”
– Richard Kudia, Director of Finance
They sought a partner with experience in both establishing billing processes and workflows, as well as expertise in eClinicalWorks®, allowing them to leverage the system to reach their billing performance targets. They recognized Curas could provide an ideal balance of both, and turned to the team for assistance.
How Curas Helped
Establishing an in-house medical billing system from the ground-up requires a good deal of discovery and planning to ensure that both the processes and technology implemented will deliver the best possible outcomes. To begin this journey, Curas analyzed all processes related to the future of in-house billing at Swedish. What would in-house billing look like, how would Swedish execute and manage it each day, who would be involved, and how would progress be monitored?
Next, after analyzing existing outsourced billing processes, Curas worked with the Swedish team to review key performance indicators for their revenue cycle management, and establish baselines for ongoing reporting and management. Once the planning was complete, Curas assisted with the eClinicalWorks® billing setup, including the development of a comprehensive claims dashboard for managing claims from submission through settlement, as well as the definition and setup of claim edit rules to reduce common rejections and denials.
The implementation was quite involved, and included a number of processes that the Curas team reviewed and modified, or designed from scratch:
- Patient Registration
- Insurance Eligibility Checking
- Referrals and Prior Authorizations
- Claims Creation / Review
- Code Correct & Custom Claim Edits
- ERAs, Splits, EOB to ERA Conversion
- Point of Service and Lockbox
KPIs Analyzed, Reports Developed:
- Days in AR
- YTD, MTD, Daily
- Insurance & Patient Charges, Payments
- Write-os / Adjustments
- Locked/Unlocked Encounters
- First Pass/Submission Claim Rates
Claims Dashboards Component, by Specialty:
- Coding Review
- Credentialing Hold
- ERA Payer Denied
- No Response
- Pending with Errors
- RCM Missing Insurance
- Coding Department
With Curas’ support, Swedish Covenant Hospital and Swedish Medical Group met their goals of transitioning smoothly from outsourced to in-house billing, establish strong systems to support in-house billing, and minimize drop-off in claims submission and payments during the transition.
Their final goal, to achieve a 90% first claim rate within the first six month of go-live, was exceeded when they achieved 91.13% first pass rate during the first complete month of billing, during which time they also matched their highest monthly receipts.
Since that time, they’ve continued down a successful path of billings and collections leveraging their newly defined processes and the capabilities of their eClinicalWorks® system.
Curas is a St. Louis area based health information technology consulting company and one of the top resellers of the eClinicalWorks® suite of products for the electronic medical office. From planning through implementation, training and support, Curas has a nationwide reputation for providing the services physicians need to ensure that their Electronic Health Record Solution makes their practice more productive. Curas’ staff of eClinicalWorks® certified specialists install the software, train end users, and assist practices with optimizing their office workflow to maximize the benefit they receive from deploying eClinicalWorks®’ products. Curas maintains its own call center providing Level 1 and Level 2 support to its clients. In addition to locations in Missouri, Illinois, Tennessee, Arkansas, Mississippi and Hawaii, the firm installs, trains, and supports users at various sites around the United States. Today, Curas supports over 1000 physicians in nearly 40 states with practices ranging in size from solo practices to multi-specialty 100 provider practices. Curas was recently named one of the Fastest Growing Companies in St. Louis by the St. Louis Business Journal, and was named to the 2011, 2012 and 2013 Inc. 5000 List of the nation’s fastest growing companies. For more information about Curas, visit curas.net.