Marshfield Clinic Health System has been striving to optimize its revenue cycle in response to financial pressures caused by an array of internal and external factors such as declining reimbursement rates, increasing inflation, a dwindling workforce and intricate regulatory requirements. The health system has put a Financial Improvement Plan into action, aiming at traditional and innovative solutions for making a substantial financial impact.
A major part of the revenue cycle optimization was setting up a multi-year Electronic Medical Record (EMR) throughout the past years. The 2023 focus is on a one-time cash flow improvement by reducing Discharge Not Final Billed (DNFB) and billed Accounts Receivable (A/R) backlogs while ensuring a sustainable net revenue boost through comprehensive revenue integrity and administrative write-off reduction.
The revenue cycle optimization efforts were broken down into four pillars of work: DNFB Reduction, A/R and Denial Management, Revenue Assurance and Pricing, and Denial Prevention. Each pillar focused on initiatives revolving around people, processes, and technology, with an emphasis on technological solutions, particularly those that transcend traditional EMR optimization.
Data Science and Machine Learning (ML) are being employed to expedite work for revenue cycle teams. For DNFB reduction and billed A/R and denials management, there is the utilization of data science and ML to identify high-value encounters in complicated system logic or worklists, determine potential fixes, build optimal team structures, and offer superior collection performance.
Marshfield Clinic Health System integrates intelligent automation across numerous revenue cycle functions. For instance, automated administrative intake is being introduced with an intelligent automation company partnership. On top of this, there’s the employment of Robotic Process Automation (RPA) for credit balance resolutions, alongside a robust data analytics system to enhance decision-making capabilities.
In light of AI’s expanding role, the health system set up an AI governance program in summer 2023 to ensure ethical and responsible adoption of AI technology within the enterprise. The initiative aims to diminish potential risks associated with AI systems.
As AI and automation solutions continue to gain ground, their impact on the workforce cannot be overlooked. Marshfield Clinic Health System is exploring various ways to deal with this, such as adjusting vendor resources based on automation levels and maintaining a cross-functional resource pool for troubleshooting and technology implementation.
As Marshfield propels forward with its revenue cycle optimization journey in 2024, it envisages enhancing the adoption of intelligent automation and responsible AI in the revenue cycle. While ongoing initiatives move ahead, the health system is also scouting for other areas to automate to augment patient experience.
