CareMedic Systems

Healthcare enterprises continue to invest in information systems to improve the efficiency and effectiveness of revenue enhancement initiatives. Automating business processes in this way requires support for operational transactions, workflow management, application integration and sophisticated business decision management.

Maximizing the efficiency and effectiveness of revenue cycle workflow is critical to the financial health of the organization. To achieve this, the right people must receive the right information to perform the right actions at the right time. A system of workflow is vital to ensure that claims are submitted correctly and on time.

According to industry estimates, reworking claims accounts for up to 80 percent of billing office time. (HFMA Wants You to Know, June 15, 2005.) It makes sense to invest in a solution that ensures timely filing and manages routine distribution tasks to reduce the need to rework claims.

The healthcare revenue cycle requires numerous workflow processes for gathering accurate and timely claims information. The complexity of compiling, submitting, tracking, monitoring, reconciling and re-submitting claims requires a tremendous amount of interaction and cooperation between multiple departments. In today’s environment, it is not unusual for departments and individuals to work in different buildings, cities and sometimes, states. In addition to dealing with the high volume of claims, organizations are often hampered by costly manual processes caused by outdated technology. As a result, they are unable to optimize revenue management.

How do you optimize the use of resources—whether human, financial or technical—to achieve maximum performance?

The simple answer is event-driven automated workflow.

Event-driven automated workflow is electronic functionality that enables all affected managers to consistently control their area’s work in compliance with the organization’s "best practices" revenue management processes.

• "Event-driven" means action is triggered by the occurrence of "events" according to a series of "best practice" business rules. Some examples of revenue management "events" include new registrations, scrubber and clearinghouse edits, payments, denials, underpayments, time periods, claim status information from payers, and any other selected data from numerous disparate systems, which affect the status of the account.
• "Automated" means the system continuously functions without human intervention, saving valuable resources and time.
• "Workflow" refers to two important functions:
• The distribution or redistribution of work onto the work lists of the most appropriate resources for completion.
• The distribution or redistribution of work away from work lists and into a suspense status awaiting another event’s occurrence, or into a final completion status.

Automated workflow is not a spreadsheet or anything else that has to be manually maintained. If you are manually performing routine, logical tasks using a computer—such as tracking claims status, assigning specific files to individuals or sorting lists to determine deadline dates, your workflow is not automated. In addition, if your work lists are static and not updated based on any pertinent event that occurs across the organization, your workflow is not event-driven.

Event-driven automated workflow is important for several reasons. Overall, event-driven automated workflow ensures that the right people across the organization receive all the right information they need to perform the right actions at the right time. Automated workflow not only assigns claims to the appropriate work lists, but also automatically updates the work lists as events occur.

In addition, automated workflow relieves managers and supervisors of the need to constantly create, monitor and update work lists, thereby freeing them to perform more valuable tasks. Automated workflow facilitates and enforces "best practices" by consistently following the most effective business rules defined by the organization.

Automated workflow enables management by exception, since it handles routine tasks and events for users, and automatically escalates potential problems to managers when appropriate.

CareMedic’s eFR solution is designed to maximize revenue efficiency for healthcare organizations by fully integrating event-driven automated workflow. By monitoring the status of every claim and taking action to alert appropriate personnel of potential losses, these unique features help our customers avoid problems like missed timely filing deadlines, which can be very costly.

For more information about how CareMedic products can help you, please contact us by completing our information request form.