GE Healthcare

Coastal Carolina Health Care Centricity™ EDI Services Payment Automation virtually eliminates paper and streamlines payment cycle to the advantage of CCHC, payers and patients

Solution overview

the facility• 15 sites, 60 physicians, nurse practitioners and physician assistants

• Practice type: multi-specialty

• Physician owned and managed

• Based in New Bern, NC

the opportunityAutomate the work involved in receiving, processing and posting third-party paper payments and help reduce the potential for errors and delays in manual payment posting.

the Ge solutionImplement the Centricity EDI Services Payment Automation solution, including full mailroom and lockbox service.

reSultS Summary • 8 percent less time spent submitting claims, rectifying

denials and issuing patient statements, resulting in accelerated cash flow within 30 days after implementation

• Virtually no manual effort required for payment processes

• Staff can devote more time to follow-ups on patient eligibility, insurance denials for new treatments, new government programs

• Ability to focus on patient collections, and payment and patient account analyses

Coastal Carolina Payment Automation Case Study

effiCient payment CyCle end to endCCHC was established in 1998. At that time, it also formed the CBO to standardize and consolidate the disparate billing and payment processes associated with a multi-specialty group practice. CHCC today consists of 60 physicians, nurse practitioners and physician assistants who specialize in Family Medicine, Internal Medicine, Cardiology, Neurology, Sleep Medicine, Urgent Care, Oncology, Hematology, Gastroenterology, Pulmonology, Critical Care and operates an Accountable Care Organization (ACO).

On its path toward optimal revenue cycle management, CCHC implemented GE Healthcare’s Practice Management solution. The advanced billing system delivered a host of advantages including the ability to automate billing and payments associated with Medicare and Medicaid and large insurance payers. Once on-line, the next step for CBO Office Manager Janice Reynolds was to consolidate and streamline the laborious and time-intensive process of receiving, processing and posting payments generated by numerous other sources, including a host of smaller insurance payers, Medicare Advantage Plans and claims tied to Worker’s Compensation, as well as various employee health programs for companies in the region.

In 2012, CCHC automated its payment processes with GE Healthcare’s Centricity EDI Services Payment Automation. In so doing, CCHC eliminated the need to hire additional staff for payments processing; freed CBO staff to focus on other areas that require attention, including value-add activities; and minimized the potential for inaccuracies in payment posting. The payment automation solution ultimately will streamline the payment cycle for the benefit of CCHC, payers and patients.

“ We wanted to consolidate and streamline the amount of time and effort that went into processing Explanation of Benefits (EOBs) remittances and Electronic Remittance Advice (ERA) files because the more we could automate, the more my team could follow up on denials and investigate payment policies with new treatments or government programs,” Reynolds says. “We also wanted to minimize the potential for errors that can happen with manual processes.”

Processing payments for smaller insurance companies and miscellaneous payers was simply taking too long, Reynolds explains.

“ Before Payment Automation, we received as many as 300 pieces of mail every day that we needed to process and post,” Reynolds says.

“ Posting payments simply took too much time and the process was very cumbersome.”

Processing payments for those payers not already being managed through Electronic Funds Transfer (EFT), involved numerous steps at CCHC. The process began with the corporate courier picking up mail at the healthcare provider’s P.O. Box. The courier would then open the mail, sort it by payer and then match the payer to the person on the CBO team responsible for processing and posting the payment. The courier would also batch the payer checks and hand them off to the CBO staff. The staff would then match paper to expected payments, physically scan checks and EOBs, electronically deposit checks to the bank, and post payments and denials. Additionally, CBO team members would copy batch sheets and route them to the finance department to verify posted payments.

With roots that date to 1962, Coastal Carolina Healthcare, P.A. (CCHC) is no stranger to change. Since its beginning, the healthcare organization has adapted to the needs of an evolving healthcare environment – and the expectations of patients it serves.

For CCHC’s Central Billing Office (CBO), meeting organizational and patient expectations required change to strengthen every aspect of its revenue management cycle, including time and effort involved in processing commercial third-party payments.

“ We didn’t want to continue with part of our payments being handled electronically and the rest being done manually. It was taking too long, and any mistakes can take more time to resolve. Plus, we wanted to decrease the amount of time it takes to work through a denial. Additionally, wanted to make things easier for our finance department.”

Janice reynolds CBO Office Manager Coastal Carolina Healthcare, P.A.

automatinG proCeSSeS, eliminatinG paperCCHC adopted Centricity EDI Services Payment Automation solution in June 2012. The solution includes GE Healthcare’s full mailroom and lockbox service, which virtually eliminates manual tasks associated with remittance.

“ Our CEO and board of directors firmly believe in the use of technology and best practices that improve revenue cycle management. The use of Payment Automation is something that makes sense for us,” Reynolds says.

Today, CCHC’s corporate courier and the CBO staff no longer spend time sorting mail, batching paperwork and checks, scanning EOBs and posting payments associated with small insurance payers and other sources not already managed through GE’s Practice Management solution.

With the automated process, all mail sorting and batching of EOBs is handled as part of the Payment Automation solution. As a first step, paper EOBs are sent to the customer’s designated P.O. Box. The mail is opened, sorted, scanned and converted to an electronic file usable for posting. The payment information is automatically integrated into the Practice Management workflow for easy monitoring. As a last step, paper checks are automatically sent directly to CCHC. Physical mail is opened, sorted, scanned and converted into an electronic file usable for posting. Additionally, paper checks sent directly to CHCC are forwarded to the mailroom service for converting to EFTs, which are then electronically posted and deposited.

The process involved in reconciling payments is also streamlined. In the past, the CBO staff would post payments and send hard copies of batch sheets to the finance department approximately twice per month. With the automated process, the CBO staff simply generates a one-page report daily with the appropriate posting data for all commercial payments and sends it to the finance department for reconciliation.

tHe reSultSCCHC began to realize benefits of GE Healthcare’s Payment Automation within one month after the automated solution was up and running. Efficiencies gained through automated payments supported the vision of a streamlined and highly focused CBO staff.

“ With the payment automation solution running smoothly, we realized we didn’t need to replace one person in our collections area who left our organization. Now other CBO staff are now freed up to help with those responsibilities,” Reynolds says. “The volume of work for my payment poster has also dropped to the point where she’s able to devote more time to helping others with follow-ups to further improve accuracy and resolve denials and things like new treatments and patient eligibility. Additionally, I no longer need someone investing three days a week scanning EOBs. Our corporate courier is also able to invest additional time helping other departments.”

Reynolds says her team is clearly able to do more with less, thanks to the combination of the GE Healthcare Payment Automation and Practice Management solutions. Although the amount of activity involved in the revenue management cycle hasn’t declined, CCHC’s CBO staff manages the workload with nine people, which compares with a team of 14 in 2008. Days in A/R have also declined to an average of 26 to 31 days from an average of 36 to 38 days in 2008.

Relative to the payment cycle, Reynolds estimates it takes her staff 8 percent less time to submit claims, rectify denials and issue patient statements associated with small insurers. Faster turnaround of payments improves financial performance. With Payment Automation, the need to copy EOBs at the end of the day is eliminated and EOBs are always included with claims. In addition, the CBO staff can generate reports at any time to analyze payment adjustments and spot trends. EOBs can also be easily retrieved for patient account analysis.

A highly efficient payment cycle is a key factor to our overall efficiency, says Reynolds.

“ Payments are posted more frequently and it’s so easy to see why something might not have posted for any reason,” she says.

“ It’s a very seamless process. It’s also very important to have a single-source payment partner I can rely on because there’s always assistance immediately available, whether it’s a formatting issue or something else.”

Reynolds says that Payment Automation ultimately contributes to CCHC’s mission to provide the highest possible level of service.

“ We have a good department and Payment Automation makes it that much better. We’re able to more quickly submit claims, post payment and resolve denials, in addition to getting statements to patients sooner. It ultimately contributes to our goal of making sure our patients are satisfied with their care and the service we provide.”

Janice reynolds CBO Office Manager Coastal Carolina Healthcare, P.A.

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About GE Healthcare GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter – great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients.

about Coastal Carolina Healthcare, p.a. CCHC is large enough to serve patients’ needs, yet small enough to retain its personal commitment to excellent medical care. CCHC’s physicians, nurse practitioners, and physician assistants specialize in Family Medicine, Internal Medicine, Cardiology, Neurology, Sleep Medicine, Urgent Care, Oncology, Hematology, Gastroenterology, Pulmonology, and Critical Care. CCHC also operates a state-of-the-art Imaging Center equipped with advanced diagnostic equipment such as MRI, CT, Ultrasound, Mammography, Bone Density and plain X-Ray, as well as an Urgent Care, Endoscopy Center, and Sleep Lab. CCHC also serves the local community by providing medical services at CarolinaEast Medical Center, the MERCI Clinic, and area nursing homes.