Swedish Covenant Hospital
Swedish Covenant Hospital Is a leading independent hospital in Chicago which includes more than 500 primary care physicians and specialists within the hospital, and over 150 providers within the Swedish Covenant Medical Group. This award-winning hospital has served the community for more than 130 years, delivering world-class care with compassion. (www.SwedishCovenant.org)
Many medical practices and physicians’ groups encounter challenges with their billing. Whether they’re doing it in-house and simply don’t have the resources or knowledge to set up the processes in a way that will lead to timely collections and claims processing, or they’re working with a thirdparty company doing the bare minimum, they find they have a system that doesn’t quite meet their needs. Solid billing practices, and the technology to execute, are key to a medical group’s financial health, so it’s important to identify the best way to address these challenges.
The Client's Need
For many years, Swedish Covenant Hospital had been working with a third-party billing company for Swedish Medical Group’s billing. The
process didn’t allow for adequate oversight and management of the billing, and there was a need to improve performance and efficiencies in this area. To achieve these goals, Swedish leadership made the decision to bring the Medical Group billing in-house, and implement a revenue cycle management system to improve its financial performance.
Leadership recognized that they did not have the in-house expertise to define billing processes or design and implement a complete billing system setup. They sought a partner with experience in both establishing billing processes and workflows, as well as expertise in eClinicalWorks®, allowing them to leverage the system to reach their billing performance targets. They recognized Ero Health could provide an ideal balance of both, and turned to the team for assistance.
Establishing an in-house medical billing system from the ground-up requires a good deal of discovery and planning to ensure that both the processes and technology implemented will deliver the best possible outcomes. To begin this journey, Ero Health analyzed all processes related to the future of in-house billing at Swedish. What would in-house billing look like, how would Swedish execute and manage it each day, who would be involved, and how would progress be monitored?
Next, after analyzing existing outsourced billing processes, Ero Health worked with the Swedish team to review key performance indicators for their revenue cycle management, and establish baselines for ongoing reporting and management. Once the planning was complete, Ero Health assisted with the eClinicalWorks® billing setup, including the development of a comprehensive claims dashboard for managing claims from submission through settlement, as well as the definition and setup of claim edit rules to reduce common rejections and denials.
The implementation was quite involved, and included a number of
processes that the Ero Health team reviewed and modified, or designed
- Patient Registration
- Insurance Eligibility Checking
- Referrals and Prior Authorizations
- Claims Creation / Review
- Code Correct & Custom Claim Edits
- Claims Submissions
- Claims Rejection & Denial Management
- Insurance Payment Posting
- ERAs, Splits, EOB to ERA Conversion
- Patient Payment Posting
- Point of Service and Lockbox
- Month End Reports
- Bank Reconciliation across Multiple Lockboxes and Accounts
- General Ledger Export Processes & Files
KPIs Analyzed, Reports Developed:
- Days in AR
- YTD, MTD, Daily
- Write-offs / Adjustments
- Insurance & Patient Charges, Payments
- Locked/Unlocked Encounters
- First Pass/Submission Claim Rates
Claims Dashboards Component, by Specialty:
- Coding Review
- Credentialing Hold
- ERA Payer Denied
- No Response
- Pending with Errors
- RCM Missing Insurance
- Coding Department
With Ero Health’s support, Swedish Covenant Hospital and Swedish Medical Group met their goals of transitioning smoothly from outsourced to in-house billing, established strong systems to support in-house billing, and minimized drop-off in claims submission and payments during the transition.
Their final goal, to achieve a 90% first claim rate within the first six months of go-live, was exceeded when they achieved 91.13% first pass rate during the first complete month of billing, during which time they also matched their highest monthly receipts.
Since that time, they’ve continued down a successful path of billings and collections leveraging their newly defined processes and the capabilities of their eClinicalWorks® system.