Process Implementation Plan for Marysville General Hospital

Problem Identification

The target for Days in Accounts Receivable is 55 days. When AR Days are at 55, monthly obligations can be met, while putting some money away into investments for the hospital's future. It has been several years since the hospital has seen its AR at 55 days. Why has the hospital's AR Days been greater than 55 for several years?

Situation Analysis

This plan will consist of implementing processes that will periodically look at all the factors that allow us to maintain a target of AR at 55 Days. Collecting information from all departments that directly have an impact on Accounts Receivable will help with implementation. The MedXL computer system has improved lost charges. MedXL has also allowed us to get payments into the right place when they arrive and it reminds us to bill secondary insurance or the patient. These areas are not a concern.

The areas we need to focus on are: admission/registration, chart documentation, claims processing, and patient follow up. There is room for improvement during admission/registration. We are not getting current insurance information. Also from 11pm-7am, nurses are taking registration information and many times the information is not readable. Overall, charting is good since implementing EMR but there are two doctors who are not great at documenting. One does not give enough detail on the patient's chart, so we cannot code the highest legitimate diagnosis. It is estimated that by charting more thoroughly would generate hundreds of thousands of dollars per year. Another does not complete his charts in a timely manner. By doing so would generate $120,000. There are too many rejected claims. There is approximately $700,000 to $800,000 a year in rejected claims. MedXL can help with that. They have a Clean Claims Module that might work for us. Lastly, collections on self-pay patient accounts are killing us. It is somewhere around 15 cents on the dollar.

Plan Implementation

Effective immediately, Marysville General Hospital will implement the following Process Improvement Plan. Admissions/registration will be required to verify current insurance and update the patient's chart with any new insurance. Nurses will no longer take registration information. There will now be an overnight admission clerk. Next, all charts will be required to have enough details so that the highest legitimate diagnosis can be coded. Likewise, charts will need to be done in a timely manner. Training will be provided to any physician who is not doing this. Next, we will invest $10,000 to implement the Clean Claims Module for MedXL. They will update it monthly and we will also invest $2000 per month for support. Next, we will offer a 25% discount to patients who pay their bill in full with 10 days. We will also allow patients to set up