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Unbilled account management in the hospital setting is a microcosm of revenue cycle management in general. The root causes of issues can be found at almost any point in the cycle, from the time the patient is scheduled through registration, charge capture, coding, and the prebilling process. Resolutions are more difficult to come by, and discharged-not-billed accounts tend to accumulate.
In 2013, NYU Langone Medical Center launched an initiative to reduce its number of unbilled accounts. The goal of the academic medical center (AMC) was to keep the number of unbilled accounts aged greater than 30 days as close to zero as possible.
NYU Langone had recently completed a major, enterprisewide implementation of a new electronic health record (EHR), which provided an opportunity to assess and optimize the supporting business processes. To seize this opportunity, the AMC embarked on the lengthy initiative to reduce the value and age of its unbilled accounts.
The opportunity was interdepartmental, so it required an interdepartmental solution. Unfortunately, at the time, NYU Langone's departments were operating in silos. Communication was fragmented, and several manual workarounds had been implemented. By the end of the initiative, however, the organization maximized the automation of all supporting processes, established regular communication across departments, and achieved dramatic improvements.
Realigning System Automation
The majority of the first year of the initiative was dedicated to training, fixing bugs, and addressing other immediate concerns related to the new EHR. The next step was to optimize the system's configuration to conform to best practices. For example, the workflow design and the logic of automated electronic work queues were enhanced to automatically route unbilled accounts to the most appropriate department with minimal adjustments. Today, most unbilled accounts go to one of three places. Each uncoded account goes to an individual coder who specializes in the specific patient's service and diagnosis. Accounts with technical billing errors are sent to billing specialists. And registration edits are routed to the relevant patient access area for resolution. To achieve this high level of automation, the AMC used a structured, iterative process, fine-tuning the work queue logic after each issue was discovered. The result has been the creation of a highly efficient process for routing unbilled accounts.
NYU Langone learned the...