MEDITECH's 'ARM' Reaches Out to Regional Hospitals, Standardizes Processes
(9/27/2007)

As hospital financial leaders can attest, tracking authorizations and referrals using the traditional paper method can be a cumbersome process. It often lacks the accuracy and information required to ensure proper reimbursement. The issue is compounded when different hospital departments track information in their own, unique way.

This was precisely the challenge facing DCH Health System, a sprawling, four-facility health care organization in Alabama, prior to implementing MEDITECH's Authorization and Referral Management functionality. "Today, DCH is managing authorizations and referrals with ease, using MEDITECH's integrated and cost-effective solution," states Mike Wilson, director of business services at the DCH Regional Medical facility.

A Centralized and Standardized Approach
Previously, DCH did not have a standardized method for collecting referrals across facilities, or even among the various departments. "Each department developed its own policies," according to Wilson. "Some worked well. Others didn't. It was a difficult system to maintain even when everything was working correctly. If a mistake was made along the way, it could be quite an ordeal to correct it."

When it came time to seek reimbursement for procedures, there was no singular place to find the information. If an insurance company denied a claim, it became a time-consuming and sometimes futile effort to collect the necessary referral data. With no set standard used by staff, there was no guarantee that once the information was located it would be complete.

"Now, we are thrilled that Authorization and Referral Management serves as a centralized place from which to manage all authorization and referral information," says Wilson. From the pre-registration process on, patient information is tracked from one location while providing access to everyone who needs it. ARM also helps ensure a standard for required information on referrals by giving organizations the ability to prevent end users from moving forward through their processes, until they fill out critical information. "This has created a very good method for being proactive about seeking claims, and it also has been extremely useful when fighting claims that have been denied for inaccurate reasons," according to Wilson.

DCH staff members echo Wilson's sentiment that a key advantage to using ARM is it promotes an organization-wide method for documenting this crucial information. "I think that is one of the biggest differences," says Vera Brzezinski, unit leader pre-registration and financial counseling at DCH Regional Medical. "With a uniform process, I know that the information will be there, and it will be in a format people can understand. It has clarified the process for everyone."

"It completely changed our way of handling these situations," agrees Wilson. "Previously, there were instances of patients being penalized through higher co-pays for denied claims on procedures that did not require us to get authorizations. Since we have instituted ARM, with the added information in the system, I cannot think of a single instance where that has happened."

Easy to Implement, Easy to Use
Not only were they pleased with having a centralized and uniform method to track this information, but the DCH staff members were also surprised by how simple it was to implement and learn the new system. End-user satisfaction is extremely important, according to Wilson, in trying to stem the high turnover rate occurring within registration departments.

"Over the years, I have seen a fair share of products which promise a lot of the same functionality that MEDITECH's ARM is bringing us today," adds Wilson. "But trying to get any of those other tools to achieve similar results would simply be too labor intensive; staff just wouldn't use it. What's the point then? The great thing about ARM is its straightforward nature, making it easy for people to quickly learn the system. That is crucial when trying to get people to adopt a new technology or policy."

Being easy to implement and use is also important because in many cases, like at DCH, the change is not just a software-level change, but it is really a cultural change for the employees as well. Gina Goolsby, an I.S. analyst in the admissions department at DCH Regional Medical, understands the scope of change involved in implementing something on an organizational level. "It can be intimidating to ask staff to change the way they have been doing something, in many cases, their entire career - even if it is a necessary change," she says. "The ARM application quelled those fears with its ease-of-use."

Improving Financial Performance with ARM
As regional hospitals continue to see more and more patients, tracking authorizations and referrals will continue to play a critical role in the economic success of hospitals. While a product like ARM may not eliminate every denied claim, it can significantly reduce the number of denials due to missing or incomplete information. According to Wilson, ARM really simplified the entire process. As a result, the site is now well on its way to increasing its financial success.

"We are very pleased with our decision to implement ARM," says Wilson. "From the functional aspects to the ease-of-use, it was exactly what we needed."

 

About DCH Health System
DCH Health System (Tuscalossa, Alabama) is a multi-facility health care organization that includes DCH Regional Medical, Northport Medical Center, Fayette Medical Center, and Pickens County Medical Center. A MEDITECH customer for well over a decade, DCH Health System is currently utilizing MEDITECH's Authorization and Referral Management functionality at its DCH Regional Medical facility. The organization's flagship site, DCH Regional Medical Center, is a 583-bed facility with over 350,000 patient visits a year. It operates specialty units for pediatrics, orthopedics, cancer and cardiology, and houses the region's most advanced trauma center and intensive care units.

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