Ancillary and Ambulatory Services – Why EHR Revenue Cycle Modules Aren’t Enough for Hospital Labs (Part 5)

Electronic health record (EHR), enterprise systems, and other practice management software fail to support the unique RCM needs of ancillary and ambulatory services. Lacking the appropriate RCM tools and solutions prohibits these valuable services from having visibility into their RCM processes and being fully reimbursed for the services they provide. As an example, MercyOne Des Moines opted to outsource its revenue cycle management, and that translated into a 15% increase in cash collections.

The time is now to evaluate and challenge the current state of RCM for your ancillary and ambulatory services, such as radiology and imaging, telemedicine, and remote patient monitoring. An evaluation should include a thorough assessment of the systems and services supporting the RCM process ― to ensure your ancillary and ambulatory services can maximize their financial contribution to the hospital and health system.

EHR systems and the associated RCM staff are often instructed to concentrate on high dollar claims. Frequently, resource constraints within the health system lead to a policy of automatic write-off of any claim below a certain threshold that requires additional effort. If your ancillary and ambulatory services claims are below the threshold and have missing or invalid information or are denied, they are NOT being worked. No one is making an effort to collect on your behalf, and instead, an automated write-off occurs.

These write-offs can make up a substantial portion of your ancillary and ambulatory services business. Automated write-offs paint an inaccurate view of your team’s contribution to the larger health system. Further muddying the financial picture, it is common for hospitals and health systems to incorrectly categorize the write-offs as revenue adjustments rather than bad debt, thereby implying the write-offs were not collectible.

To run and grow a profitable ancillary and ambulatory services business, you need easy access to specific data required both to maximize reimbursement and to gather insights into the health and wellness of your business. Many EHR systems are unable to provide quick or accurate answers to the questions posed above, as well as any ancillary and ambulatory services-specific key performance indicators (KPIs). You need to understand the profitability of specific services and clients to ensure your growth is focused in the proper areas.

Often a health system wants to use an EHR system because the finance team, for example, thinks it will be more cost-effective. A purpose-built RCM solution and service more than pays for itself by increasing cash collections while reducing labor costs, write-offs, and compliance risk.

Purpose-built RCM systems deliver the information needed, often in real time. Analytics help organizations leverage data assets to understand how the ancillary and ambulatory services organization is operating, e.g., by payor, by service, etc. Purpose-built RCM systems provide this insight as well as using analytics to improve business process automation, forecast accuracy, and pricing analysis.

Ancillary and ambulatory services also have specific business intelligence (BI) needs that cannot be met by EHR systems, such as benchmarking to enable tracking and comparing financial and operational performance to industry peer groups and performance against ancillary and ambulatory services-specific KPIs to understand trends and drill-down capabilities to view details.

As you move forward, this Outsourced Billing Quick Reference Guide’s list of considerations and questions may be useful in the decision making process.

Read Now