Case research: How MetroHealth diminished denials by 44% by fixing front-end registration

Problem: Too many registration errors had been caught too late

Health techniques are beneath fixed strain to enhance money circulate whereas doing extra with the identical or fewer sources. For MetroHealth, rising declare denials had been the symptom of some deeper workflow issues. Busy affected person entry groups relied on guide registration processes, resulting in inevitable protection errors and patchy eligibility verification.

Mary Ann Olschlager, Director of Income Cycle Operations at MetroHealth, describes how these errors labored their method into claims and billing, creating extra strain downstream:

“Our backend groups had been bombarded with rework. Morale was low, and we had been spending time fixing what by no means ought to’ve been damaged.”

Mary Ann Olschlager, Director of Income Cycle Operations at MetroHealth

Employees had been spending an excessive amount of time chasing down lacking or incorrect Information that ought to have been resolved earlier than the affected person go to. Turning to third-party companies to fill the hole was proving pricey and inefficient.

They wanted a system that would remove guide steps and take away pointless touchpoints. Might MetroHealth discover a higher technique to cut back the guide burden and repair points earlier than they result in denials?

Answer: Automation, with a human contact

By working with its present accomplice, Experian Health, MetroHealth launched a brand new automated answer, referred to as Affected person Entry Curator™ (PAC), that consolidated a number of registration checks right into a single, streamlined course of. This was an improve to their present use of Experian Health’s Actual-Time Eligibility, with PAC’s AI and machine studying Technology having caught their consideration.

With Affected person Entry Curator, eligibility, coordination of advantages primacy, Medicare identifiers, demographics and protection discovery may now be dealt with in a single transaction. Outcomes had been returned on to their digital Health document, which was excellent news for workers who now not needed to bounce between portals and web sites to examine affected person particulars.

Onboarding was simple, with no new screens or additional steps for registrars. Automation ran shortly and quietly within the background, lowering last-minute fixes and follow-up work.

After the brand new system was in place, MetroHealth continued collaborating intently with Experian Health to refine the setup.

“This answer really is a partnership. Experian didn’t simply flip IT on. They met with us persistently to tweak and enhance IT.”

Mary Ann Olschlager, Director of Income Cycle Operations, MetroHealth

Experian consultants additionally helped resolve particular ache factors, like correcting Epic mapping for a posh payer. Olschlager says employees felt extra assured as a result of nothing essential was being missed.

“One among our contact middle employees instructed me, ‘I really like IT. My job is a lot simpler.’ That’s once I knew we had an actual win,” she says.

Downstream groups additionally appreciated having much less firefighting to do, as their day by day workload turned extra predictable. Spending much less time fixing errors and calling sufferers gave employees extra bandwidth for higher-value duties. Christina Adkins, Supervisor of Money Utility and Fast Registration, added that since extra errors had been being caught upfront, her crew was capable of focus extra on declare edits, fairly than transforming denials.

Outcomes: Much less rework, fewer denials

The numbers lined up with the employees expertise:

– 44.1% discount in coordination of advantages denials

– 20.3% drop in registration denials

– 37.3% lower in eligibility denials

These reductions additionally translated into tangible operational and monetary advantages. With fewer denials to remodel, MetroHealth diminished its reliance on third-party contingency companies, reducing charges by 35% – and saving $250,000 per yr. The group additionally reallocated three full-time employees members to different departments, boosting capability in these areas with out squeezing groups.

Extra time for significant work

Routine choices that had relied on expertise and reminiscence had been now not left to probability. As soon as the guide burden was faraway from day-to-day registration work, there was no urge for food to return.

“Affected person Entry Curator eliminated the guide work. We are able to’t return to human decision-making. That’s a factor of the previous for us now.”

Mary Ann Olschlager, Director of Income Cycle Operations, MetroHealth

Importantly, whereas automation eradicated repetitive guide duties and choices, IT didn’t take away folks from the method. As an alternative, IT modified the place they targeted their time and a focus.

Reflecting on their expertise, MetroHealth leaders additionally emphasize the significance of human collaboration throughout departments, alongside continued assist from Experian Health to construct on early enhancements and embed them in on a regular basis apply. As Adkins says, “Affected person Entry Curator is environment friendly and intuitive, with a lot Information in-built. We are able to’t think about going again.”

Find out how Affected person Entry Curator makes use of AI to automate eligibility and protection checks at registration.