How OSF HealthCare Positions Itself for Revenue Cycle Success

"We've learned alot from being pro-active," the system's director of ministry managed care said. 

Looking at OSF HealthCare’s EHR dashboard is like watching a well-oiled machine at work. In fact, Cathy Beebe, director of ministry managed care, enjoys seeing how processes seamlessly flow through one another.

“It’s kind of fun to see how well we’re doing,” she told HealthLeaders. “It also tells us how many FTEs it will save us the more we automate things, so that’s really rewarding.”

As hospital systems struggle to contain costs, they also have to make sure they’re capturing the appropriate revenue through an efficient payer system that leverages automation along with best practices for those tasked with ensuring proper payments. It’s a relentless approach that OSF uses daily with the rigor of a forensic accountant.

An efficient EHR is only the tip of the iceberg for the system’s automation—which has contributed to the success and health of the system’s revenue cycle. The system has automated a number of processes, including eligibility, payments, and claims.

Despite those achievements, much like other health systems, OSF has to stay vigilant when it comes to dealing with payers. While payers themselves have also invested in and implemented automated and AI solutions in their operations, many of the processes health systems complete for claims are still done manually and require a considerable amount of back and forth.

While the system is proactively able to send medical records with claims, Beebe stressed the importance of figuring out “the sweet spot” when sending medical records to payers due to the cost.

The system’s data analytics team is performing queries to learn more about the pattern of denials among various payers. Additionally, the denials team is working to discern when to attach medical records to a claim considering how costly it is to do so.

Beebe said that two payers have given the system a baseline of what a claim needs, but there isn’t much flexibility.

Another strategy that has worked with payers has been getting them to utilize their EHR’s payor payment platform, which adds to the system’s suite of automated solutions.

“I’m always promoting that [option] with the payers because it promotes automation and the more we automate with the payers, the less they bother us,” she said.

Prior authorizations are a consistent issue in the revenue cycle, and Beebe has been pushing payers to automate the system’s prior authorizations.

“Sometimes I have to threaten if they don’t get that module turned on, I will turn of the clinical data exchange because we could force them to have to request paper medical records through a vendor,” she explained.

“I hate to be mean, but sometimes we have to do that.”

Beebe’s department is responsible for loading all the rates in the system and her role in particular negotiates payer contracts. To ensure that rates get loaded into the system accurately, payers must also have their systems loaded accurately, she said.

“We have weekly underpayment reports and if we suspect that a payer has their rates loaded wrong, we’ll reach out to them,” she said.

For Medicaid payers, whenever there are changes to reimbursement rates, the system will hold its claims and work with the Medicaid configuration teams at each payer to make sure they have the rates loaded correctly.

“We’ve learned a lot from being proactive,” Beebe said. “It pays off.”