Any discussion of converting data into cash begins and ends with understanding what constitutes usable information. For the world of laboratory & pathology, usable information comes out of data elements spit out by generally horrible information systems. CPT codes? Diagnosis codes? Payers? Rejections by ANSI codes? What does it all mean?
Short answer: NOTHING. Data without analytical frameworks is like looking through a microscope without focusing the microscope or producing an automated clinical test result without a critical value. What does it even mean? Data begins to mean something when it is analyzed and structured in digestible segments, wherein conclusions can be deduced or inferred from which actionable information is borne.
IT’S ABOUT THE INFO
Information’s value expands quickly with awareness of surroundings or how outside considerations impact the meaning and applicability. Consider the idea of “backing up into a laboratory or practice.” All of a sudden, when we consider reportable revenue cycle management (RCM) information in the context of laboratory processes, we can marry tests to revenue and expense, creating understanding about profitability. Or, often overlooked, rejection reasons point back into upstream processes in labs or practices, or even hospitals or surgery centers where process issues confound the ability to bill a clean claim. Information emanating from the RCM process can profoundly impact operations and profitability if developed properly and used with open minds.
Poignantly part of this discussion is how to find sources of good information that can provide the framework for actionable steps. Traditional “billing reports” are simply awful, especially those still on green-bar paper (truly paper or in electronic reproduction). These reports of all kinds regurgitate continuously useless bits and bytes that are connected to no foundation are unhelpful because they draw no conclusions other than, “Yep, we billed $10,000,000 in charges and collected $4.3 million in cash.” Do we really care about the obvious?
Unfortunately, RCM reports do not often exist in volume or quality but are relegated to the like of billers’ reports. You’ve seen them. Lots of undigestible data elements unless you want indigestion. The data elements often result in observations and perhaps conclusions, but they are linear at best with little depth.
Therein lies the ultimate answer: depth and breadth of perspectives, conclusions, action items, answers to age-old issues and problems.
Where does that level of understanding originate? How do you get your hands on sophisticated information versus outdated data? You can call it many things; but, most frequently, it’s artificial intelligence (AI) or machine learning or a few other terms. Therein lies the greatest potential strength of understanding and action.
First up: what is it? Where does it come from? What does it mean? How’s it used?
TOOLS OF THE TRADE
However, before we embark on the aspects of this technology, it is actually used by very few in ways that make a discernible difference. It’s talked about a lot, even hypothesized as if it is real. One needs to be very careful when navigating the avenues of empty promises. How does it work? Where are the results? What are they? We’ll get back to that.
The nexus for success is tying the AI technology to sound A/R process with layers of fundamental follow-up leading to full adjudication of claims. The key focus is probability of payment, as instructed by the AI software. The best possible results come from looking past the traditional average trial balance (ATB) to view A/R issues or opportunities in broad scope, viewing hundreds—even thousands—of claims with the same denials or problems within or across multiple payers. It’s a view into A/R that cannot be accomplished via any other mechanism—certainly not within traditional tools.
That said, losing sight of traditional tools is unwise. Using an AI tool should always be augmented by targeted tools like the ATB or A/R aging, combined with advanced appeals tracking software, to make sure that every account at every level can be identified for action and resolved.
ALL ABOUT THE RESULTS
Results. What are they? The Coronis Ai4AR service line has created a new sense of focus in performing A/R tasks, ultimately generating more cash for clients. Best described by experience, the results of Ai4AR for Coronis Laboratory & Pathology clients are:
- More cash, more quickly
- Increased efficiency
- Less cost in performing A/R tasks
- Increased success rates = increased satisfaction for staff and clients
- Better process management upstream
Better process management upstream is something to consider.
- Clients educated on data and process elements negating success in billing
- Internal edits reduced substantially for quicker claim resolution
- Clearinghouse and payer edits greatly reduced
- Denial down materially
- ROIs improved with increased cash
At the end of the day, it’s not about software, which is often touted as solving for “X.” The key to applying AI is to integrate software with good old-fashioned processes and sage expertise to drive better cash realization.
Michael J. Ferrie, MBA serves as the president of Laboratory & Pathology division for Coronis Health. Mr. Ferrie has over 25 years of diverse experience in healthcare, including, starting and operating a physician billing company, directing a practice management firm, owning/operating a compliance management company, directly managing physician practices, building and managing independent physician associations (IPAs), consulting in health care marketing/sales, acquiring and selling health care organizations, and physician recruitment. Mr. Ferrie’s experiences stretch across very large multi-specialty groups, focused single-specialty groups in several medical fields, independent specialty laboratories, and reference clinical laboratories. Mr. Ferrie molded the Coronis Health’s Laboratory & Pathology division to focus on what he refers to as “the practice management approach”. In billing, this approach serves the needs of pathologists as if Coronis was the pathology practice. With this frame of mind, concentration of activities allows stronger results to come forth. Mr. Ferrie holds a Bachelor of Science in Business Administration degree from Georgetown University and a Masters of Management degree from the J. L. Kellogg Graduate School of Management at Northwestern University. He can be reached at mcferrie@coronishealth.com or 314-503-8775.