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 third party 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.
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 RCM360 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, RCM360 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, RCM360 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, RCM360 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 RCM360 team reviewed and modified, or designed from scratch:
KPIs Analyzed, Reports Developed:
Claims Dashboards Component, by Specialty:
“The RCM360 Health team was instrumental in driving the success of not only our transition to in-house billing, but also in helping us meet our goals for first pass claim rate more quickly than we ever thought possible. Their knowledge of eClinicalWorks®, medical billing workflow, and the claims process helped deliver the best possible outcomes for this project.”
Richard Kudia
Director of Finance
With RCM360’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.