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We’ve recently had some podcasts and discussed the concept of overcoming resistance within billing departments on implementation and using analytics systems. I wanted to follow up on that because there are many different aspects to this, and it isn’t all overcoming resistance. It isn’t just that people are resistant to using it. This is a relatively severe and complex issue that involves everything from fear to lack of training. We’re going to dive into this a little more.

Discuss the issues with RCM analytics implementations

Why are there so many issues with implementing and successfully utilizing analytics systems in revenue cycle management? How do we get buy-in? Ultimately, how do we get success? This is important to our business because we want people to use the products that we deploy. But also, it’s essential to the industry. I mean, how do we utilize data to be more successful and to move forward? We are somewhat evangelical in that mission in trying to prove it. That’s why we’re doing all of this. It isn’t just to make money. Our team has been successful in the past, so we’re doing okay. We want to change things. Further, we want to improve things. In addition, we want people to make progress.

Find the obstacles

One of the things we’ve noticed is that we’re getting a breakdown in success in two primary places. The first one is early on in implementation where we’ve got buy-in from the executive team owners, we have a HIPAA BAA signed, and we don’t end up getting data. If you don’t have data, then obviously, there’s no implementation. Nothing goes forward. The second one is at the analytics stage where we’ve gotten data, we’ve deployed the system, we’ve got people presumably using the system, and we have success in one part of it, which is using the denials management workflow routing application or module of that. Still, there isn’t a robust uptake of utilization on the analytics portion of our denials management.

It seems like we haven’t gotten buy-in from the organization sufficiently when it comes to the implementation side. This is at least my thought at this moment. It seems to be at the owner executive level. I say that because they commit resources, but it may be that some combination of training, automation, trust, and other things derail us from getting data.

Starting and restarting

Because there’s been some buy-in at the owner executive level, the clients provide resources to get data for us to load into denials management, or data warehousing, or whatever it might be (in this case, we’re talking about denials management). A billing manager typically may spend several hours successfully getting data for us. Eventually, they give up, and it sort of fades to black. They go away, at least for some time. Sometimes, they come back several months later and say, “Hey, what happened?” Well, if you didn’t do anything, we can’t do anything without data. So nothing happened.

If it’s a system that we know well, we can train the individuals. We can automate, we can do things to make sure that we get the data so that those clients don’t have to spend all that time wandering around in the dark. Also, trying to figure out where in their systems can they find these things because the reporting frequently stinks in a lot of billing systems and practice management systems, admittedly.

Playing detective

When I say “billing stinks,” there’s a lot of different ways something can stink. In this particular aspect, I’m referring to the ability to find a report that gives you exactly what you need. It doesn’t mean the report doesn’t exist. It doesn’t mean the report isn’t there. Typically, we’re talking about something relatively simple like charges for a detailed report. It’s just that finding the report that includes the correct fields can be challenging. It can take hours at Word. Maybe, it’s not even there. Perhaps, it requires a custom report. Who knows? I mean, that process of “If I haven’t found it in a couple of hours, is it because I just haven’t found it yet or because it’s not there?” becomes very difficult.

If we know the system well, for example, you have eClinicalWorks. We can tell you exactly where to go into their online reporting to find the proper charges detail report. We say, “Go through this. Then, click this, do this, do this. Get this, pull this report.” And we can do the same, for example, if somebody has TriZetto or Gateway because, again, eClinicalWorks in most systems don’t have denials’ information in their reports. We can’t get those denial codes. But if you’re using TriZetto or Gateway as the clearinghouse, we can tell you precisely what to do to get the 835s and go through those steps. But that is still a lot of work for a billing manager to do, but typically at least that can happen.

What systems are in use?

Suppose it’s not a system that we know intimately and that well to automate or make it simple and easy for the client to go through those steps. It frequently doesn’t work. How we have been successful with clients, the ones more recently that have been successful, are the ones where the clients have given us access to their systems. But this requires a lot of trust. 

Many organizations have a generalized fear around someone seeing or accessing their data or their systems. For the most part, I don’t think this makes a lot of sense because if you’re going to give us all of your data for analytics, we’re going to see it all anyway. But somehow, going into the systems is scarier than your clearinghouse or your billing system.

Most systems should have permissions set up such that if you give us access to the system, you can set it up so that we cannot submit claims if that is the fear. Of course, we wouldn’t submit claims anyway. We’re not going to enter claims like a fake. I don’t even understand what motivation is. There are a lot of conspiracy theories out there in the world. The ones that I think have some value are the ones where it makes sense: the motivation, why somebody might do that.

Fake claims do not make sense

Might a pharmaceutical company have the incentive to sell a costly treatment of something with a cheap or free alternative? Sure, absolutely. That I could see happening. But who has a financial incentive in pretending that we got to the moon when we didn’t? Those kinds of things don’t make any sense. So why on earth would an analytics company want to create and submit fake claims? How will we benefit from that? It doesn’t make any sense to me. Understanding that fear, set up the permission so that you don’t have to do that.

That’s where we’ve been the most successful. It is taking it out of the billing manager’s hands or the person assigned within the organization because they flounder around for a few hours trying to find data, and they’re not successful. They’re busy. Also, they don’t have a lot of time. They’re already overworked. There are already too many things that aren’t getting done that need to get done. It’s not just the amount of time involved, but it’s the uncertain outcome. I might spend a lot of time doing all this and still not get the data because of what goes through the heads. So why should I bother?

Key takeaway

That’s what we’ve suggested. If it’s a system we know well, great, we can give you the steps. If not, provide access and let somebody in there to do all the work for you to find it. Then, you’re ensured of success and implementation.