At a Glance

Background and Challenge   

A healthcare system in Pennsylvania on MEDITECH was frustrated by charges not moving accurately from ambulatory workflows to patient accounts. Because front-end workflows were generating accounts without documentation, the organization was unable to connect charges to providers and locations. The result was that 90% of their ambulatory claims needed to be manually reviewed and edited for accuracy, which slowed down their entire revenue cycle.  

Solution   

The client engaged Tegria to conduct a four-week, on-site assessment and workflow optimization sprint to get a better understanding of the operational side of their revenue cycle. The impartial assessment included a series of staff interviews, workflow shadowing sessions, independent system reviews, and data analysis. After all the findings were compiled and presented to the client, Tegria moved into a sprint to implement best practice solutions and accountability.  

Key improvements included:  

Patient Care

• Automating vaccine, administration, and cardiology charging 
• Implementing Ambulatory Visit Provider and Medical Necessity functionality 

Billing & Follow-up 

• Improving Reimbursement Management Rules’ processing of CPT II codes  
• Streamlining coder communication and assignment workflows 
• Building additional payer-specific claim edits and account checks 
• Education on Financial Status Desktop for consistent work relative value unit reporting 

Patient Access 

• Creating new appointment booking process to ensure all documentation is linked to one account 
• Implementing Scheduling to OM link and Eligibility Verification tool  
• Enabling front-end staff to create authorizations using Referral Management 

Results   

MEDITECH workflow optimizations produced the following outcomes:  

• 90% decrease in claim rejections through upfront Medical Necessity checking  
• 60% reduction in the volume of claims needing to be manually reviewed and edited 
• Increased front-end payment collections
• Cleaned up more than 9,000 accounts through better processing of CPT II charges