Marquette General Hospital, a Duke LifePoint Hospital
For-profit, specialty and tertiary care center
Marquette General Hospital is a thriving regional referral center with more than 12,000 inpatient visits a year. The hospital faced a growing unbilled rate, primarily due to a backlog in processing medical records into the electronic medical record (EMR) for coding, and an overall coding backlog.
Maintaining a low unbilled rate in a fast-paced hospital is a complex process requiring a tight choreography of people, departments and systems to transmit patient charts seamlessly to clinicians, HIM staff and coders so that bills can be finalized shortly after discharge. One hitch along the way, whether from an incomplete chart or inefficient workflow, can lead to delayed billing worth millions of dollars. It’s a familiar challenge that most providers eventually face.
Parallon’s topline review of Marquette General’s HIM department revealed a high percentage of charts pending EMR processing, which was causing a major coding backup. At the same time, gaps in clerical workflows and coding processes added to a growing unbilled rate. Chart collection, scanning and coding procedures were more labor-intensive than necessary. Staff commonly spent several hours a day walking the hospital floors collecting missing charts, and the EMR was not fully optimized to quickly identify and resolve incomplete charts. It was time to reengineer the hospital’s HIM department.
HOW WE HELPED
Marquette General needed strong expertise and proven results to control unbilled dollars and chose Parallon to help transform its HIM department. This transformation involved creating metric-driven process improvements spanning the entire chart reconciliation cycle. It also required streamlined clerical and coding procedures that focused on meeting productivity and quality standards around collecting, prepping, scanning, indexing, analyzing and coding charts.
On the clerical side, HIM staff and clinical departments partnered to reduce chart collection to once a day. Staff answered the challenge of scanning a higher number of charts per hour to reach national benchmarks. Parallon spearheaded a campaign to reduce the coding holdup by increasing EMR utilization and training. A new EMR monitoring system assigned standard reason codes to incomplete charts three days past discharge. Instead of HIM staff communicating via e-mail to resolve issues, incomplete charts, for example, were automatically assigned to clinical department queues in the EMR, enabling coders to track questions and responses, and finalize accounts more quickly.
The coding staff received “must-achieve” daily coding goals for certain discharge timeframes, and coding leaders monitored total records, followed-up on incomplete accounts and created overtime schedules to bring down the department’s total unbilled rate.
With new infrastructure and productivity benchmarks firmly established, Marquette General’s HIM staff is reconciling and coding patient bills faster and more accurately. Accounts are kept up-to-date each week. Hospital leaders are closely monitoring progress and using “reason codes” to quickly identify bottlenecks that are holding up the largest amounts of cash. With smarter work processes and regular feedback, the staff is motivated to improve skills and performance.
The results are evident in the hospital’s significant cash flow increase. Today, Marquette General’s unbilled rate has dropped from $8.5 million in accounts that are pending coding for more than three days post-discharge to approximately $1 million each week. Marquette General has reported other cost savings as well. By standardizing performance and outcomes for all HIM operations, the HIM department was able to reduce the number of full-time employees by nearly 30 percent.