1. Physicians & Allied Health Professionals- Engines of Production
Physicians and providers are the engines of production that health care delivery organizations rely on to deliver care and generate revenue. Every revenue cycle starts when an encounter is scheduled or care is delivered. As such, we organized our efforts not by the size of health care delivery organizations, but by category of providers. The categories are Physician Groups, Hospitals, and Other HDOs.
2. Software Applications & Systems – Where Data is Stored
“In addressing the need of providers to rely on these pre-internet and pre-web-scale systems, while incorporating new capabilities offered by web-scale era solutions like ECM, we had to engineer and deploy two foundational systems.”
In thinking globally, we made sure that the solution we engineered takes into consideration and enhances the capabilities of applications and legacy systems already in use. Although these legacy systems were conceived and built pre-internet, and before the term web-scale even existed, they are mission-critical and providers depend on them to manage their operations. We also wanted to make sure we accounted for the inevitable introduction of new systems and the need to work with them. After all, machine to machine workflows and processes are at the heart of ECM.
In addressing the need of providers to rely on these pre-internet and pre-web-scale systems, while incorporating new capabilities offered by web-scale era solutions like ECM, we had to engineer and deploy two foundational systems. One named CHC Enterprise to incorporate and manage ECM at the enterprise level and a second named CHC Health, to manage data and processes at the health care industry level.
CHC Enterprise is a platform and an application that ECM resides in. As an application, CHC Enterprise provides user security management, unified standard user experience, and data repository just to name a few capabilities. As a platform, CHC Enterprise provides interoperability with legacy systems and third-party systems.
CHC Health is the first worldwide industry-level application that is a repository of all things health care, starting with all that’s required in running digital revenue operations with the goal of revenue optimization. The use of the National Provider Identifier (NPI) is a great way to illustrate the value offered by CHC Health. NPI is a dataset of all providers in the U.S. authorized to bill Medicare. It is updated weekly and contains over 6 million records – and growing. NPI is used in everything from identifying a provider when referring a patient, to quality metrics published by Medicare. As Medicare updates the NPI dataset, CHC Health is updated so that all our current and future solutions, including ECM, make use of it. In the near future, CHC Heath repositories will be available to 3rd-party systems so that a single clean and complete dataset of all public domain datasets are available to all – reducing defects and cost while improving outcomes.
3. Revenue Operations – How Work Gets Done
When it comes to revenue cycle management, until very recently, providers have had two options to get work done – and they are both labor-intensive and highly error-prone. The options have been to build a team internally, outsource to a business service provider, or usually a combination of the two. However, regardless of where tasks are completed, inhouse, or at a service provider, both options are labor-intensive, error-prone, difficult to scale and manage, with limited visibility.
This is where ECM steps in. ECM is the first Digital Revenue System designed to identify and work denials and follow-up on claims. ECM is an alternative way to get work done by offloading denial and claim follow-up tasks from users. ECM is designed from the ground up to engage in machine to machine (M2M) task completion. ECM only engages users when ECM itself can not complete a task. In harvesting computing power to get work done, errors and defects are dramatically reduced or eliminated altogether, far more tasks get completed, the need for supervision and management is reduced, visibility is improved, while the ability to scale is increased by an order of magnitude. All this lead to improved revenue and far better ability to manage operating costs.
ECM deals head-on with the greatest constraining factor facing providers in their attempt to collect more while managing cost – payroll. Providers are all constrained by how much can be added to the payroll. The only way to improve collections is to meaningfully improve the productivity of current personnel. ECM makes that possible.
“ECM is the first Digital Revenue System designed to identify and work denials and follow-up on claims.”
4. Payer and Other Software & Systems – Where Remittances & Denials Happen
This area is perhaps where our global view can be best described as it relates to revenue operations. Most, if not all, revenue operations consider collections as an indicator of how well they have done. Of course, the aggregate of remittances, denials, and open accounts represent collections. The largely missed but obvious fact is the most accurate data regarding collections isn’t from the providers’ systems, but rather the payers’ systems.
ECM design provides connectivity and interoperability to:
- 460* Payers including every Medicare carrier from American Sonoma to Puerto Rico and every U.S. state in between for electronic claim status inquiries. ECM connects to every payer that offers electronic claim status.
- 10,174* Payers for professional claims
- 9,776* Payers for facility claims
- 137* Payers for dental claims
This allows ECM to work with the most current and accurate data available directly from the payers’ systems – real data that matters when it comes to remittances and denials.
* As of September 2020. Subject to change. Payer enrollment and contract may be required.