2564 Good Sameritan case study

A RelayHealth Case Study
Smoothing the Path to Faster Payments
Good Samaritan Health System
2
Introduction
Introduction
Critical Issues
Results
Rapid change, right decision
Quick Facts
Tracing errors
Most of the obstacles on the way to successful payment are small. The problem is that
there can be a lot of them, and no matter how small or large, they cause delays. At Good
Samaritan Health System in Lebanon County, Pa., Sue Hauck’s financial services team is always on the
lookout for ways to ease the path to timely payment.
With a close eye on the department’s acceptance rate, Hauck and her team use a combination of process
and technology to find and fix errors before they cause a claim denial. RelayAssurance™ Plus is the most
important instrument in their bag, according to Hauck,
Critical Issues
director of corporate patient financial services.
“It’s a great management tool—it allows us to look at our key
metrics, and it’s a centralized way for us to really look at what
is going on with our claims,” she said.
• Low acceptance rates on claims
• Frequent payer changes slow down remits
• Productivity metrics must be submitted daily
Results
• Acceptance rates rose from 70 percent to 90 percent
or higher
• Bridge routines written to alleviate payer issues
• Metrics on claims billed per worked hour collected
in minutes rather than hours
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Introduction
Critical Issues
Results
Rapid change, right decision
Quick Facts
Rapid change, right decision
Interestingly, the financial services team did not
initially view RelayAssurance Plus (then called
ePREMIS®) that way. In spring 2009, the department was
experiencing rapid change. Its claims system was being
discontinued, and the entire health system was about to
upgrade to McKesson Paragon.®
Despite the chaos, the
Tracing errors
department was able
to get the new claims
system up and running quickly.
“The decision was made in a very short period, and at the
time, we didn’t realize all the benefits that would come from
it,” Hauck said, referring to how RelayAssurance Plus enables
the department to successfully raise its acceptance rate
through clear, understandable and timely edits.
“We had to implement a claims processing system sooner
than we wanted to,” said Mary Jo Fies, systems support
“Because the edits are in place before the effective date, we
analyst. “ClaimTrack was being discontinued, and we weren’t
can let our coding department know what’s coming, and
ready to go live with EC2000. For about a year, we were live
they can make the change,” said Bonel Borrelli, a biller. “That
on two systems and had two customer ID numbers, which
means we get our bills out in a more timely fashion, and the
meant we needed a method for preventing duplicate claims
claims are cleaner,” added
and saving the additional
Cynthia Schwalm, patient
Quick Facts
time and staffing resources
accounting manager.
it takes to resolve them.”
• Hospital: Good Samaritan Health System, Lebanon
County, Pa.
• Solutions: RelayAssurance Plus, RelayAssurance
Attachments
• Beds: 172
• Employees: 1,450
• Medical Staff: 429
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Introduction
Critical Issues
Results
Rapid change, right decision
Similarly, the department’s use of RelayAssurance™
Attachments for workers’ compensation and auto insurance
claims led to faster payments, fewer denials and lower
postage costs. “There are times when a claim has several
pages of medical records that need to be sent,” Schwalm
said. “In the past, we sent it by mail and followed up by
phone. Sometimes we were told they didn’t receive it, and
we had to start over. Electronic claims attachments are
faster and traceable.”
This facilitates the identification of
areas causing delays in payment.
Quick Facts
Tracing errors
Recently, Schwalm saw a drop in the
acceptance rate and used a field error
report to trace it to a dictionary entry in Paragon® with a zip
code of 00000. “We went into our reference master and fixed
the information that was there, and we’re in the process of
also making the correction in Paragon,” she said.
Being able to create custom reports is a tremendous
timesaver, Fies said. “We also create our own bridge
Tracing errors
routines. Payers change things all the time, and this helps
The department’s ideal acceptance rate was set at 90 percent.
us solve our own problems without going to support.” Fies
Currently, it has even surpassed this goal by running at
added that she can try out the routines in the test mode
90 percent and higher. Both Hauck and Schwalm are
of RelayAssurance Plus to make sure they work and don’t
confident they can maintain and even improve upon
affect other components before they go live.
this success.
Moving the acceptance rate up a notch higher is a team
Timely reports are a large part of the effort. In addition to
effort, Hauck said. “We’re looking at the kind of edits
a daily email with the acceptance rate, Schwalm and her
we’re seeing, and we’re working with Health Information
team regularly use the edit reports and the hold-bill report.
Management and other departments to get errors cleaned
“The report capability in RelayAssurance Plus is very good,”
up so that when we get it, it’s virtually a clean claim, and it
Schwalm said. “I love the edit report, and I can quickly break
goes out the door.”
down the hold-bill report by holds or by payer.”
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Introduction
Critical Issues
Results
Rapid change, right decision
RelayAssurance Plus also helps make gathering productivity
metrics faster and easier. Without a centralized data
system, it would take Schwalm two to three hours to pull
together the data on claims billed per worked hour for all
payers, something she does daily as part of a system-wide
productivity effort. With RelayAssurance Plus, the process
takes five to 10 minutes.
Benefits like these lead Hauck to describe RelayAssurance
Plus as a critical part of her department’s workflow. “We have
had situations where we’ve decided against a third-party
system because it was not able to integrate appropriately
with RelayAssurance Plus,” she said. “We would rather have
a few manual steps than choose something we’re not
confident will flow data correctly into RelayAssurance Plus.”
Quick Facts
Tracing errors
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