How a Healthcare CFO Built a Smarter Revenue Cycle With Automation

Speaking of the scrubber program, just to be a little tactical here, um, how do you act- how does that work? Uh, you have built many things that catch from underpayments to denials of prices.

Um, what does the operation look like day-to-day?

So the scrubbers are automated checks, uh, of, of the database.

It's, uh, it looks into appointment scheduling, charge entry, looks at, uh, techs that do workups, uh, looks at all sorts of areas in the s- in the, uh, database of our EHR.

Every night we have SQL code that investigates the data based on what we've built over the years.

Uh, oh, and it, we-- This has been a seven-year process.

It started with just a few lines of code, and it's expanded over the years.

But, uh, it runs this code every night that, uh, uh, based on the language that we set up.

When we first started doing it, we started really just basic ideas.

Uh, what are the most common easy mistakes that might happen? And let me just say this, I'm-- when I'm talking about mistakes, our practice, we see 300 patients a day, and staff are gonna make mistakes.

I expect that.

I don't have, you know, the per-perfection is just not, uh, attainable.

But what we're, we started with, what are some of the, uh, headaches that we deal with? What are some of the things that are easy fixes? And, you know, if we didn't schedule a follow-up...

So with retina injections, there's, uh, they had to be at least 28 days out.

Uh, and if we, if somebody at the front desk scheduled something within that 28 days, I wanted the supervisor to get an email that said, "Hey, this happened.

Uh, we might want to, you know, you might wanna take a look at it." Another example, if the coders actually put in the wrong number of units for a procedure, such as a J code for medication.

And so, uh, one, once we built that, then we were, uh, kinda getting off onto the, it, it, uh, it turned into show and tell.

I'd be like, "Hey, look, here's something that we've been able to build on the billing side," or, "Here's something we've been able to build on the appointment side." A-and so it's built, it's grown from there.

When we create them, I typically, uh, have the person who saw the issue or identified the problem join in a conference call with our SQL programmer and me, discussion of what happened, what we're trying to avoid going forward, and how we can isolate the problem.

Um, our e- department heads w- or, uh, department supervisors will get these, uh, scrubbers every day.

Other scrubbers that we build go to different personnel to monitor those areas.

Uh, the recipients will look at these flagged emails, and if it's, you know, it's a problem, oh, we scheduled a, a person under 16 years old for a doctor who doesn't see kids, you know, we g- we handle it.

If it's a billing issue, our coders will rebill as needed.

If, for example, it's a false positive situation where if they, if we did bill a second injection within two weeks, but it's just patients coming back for the other, for the opposite eye, what we do is we have a- All clear code for that particular visit.

So the, that will tell the PM, the practice management software, "Okay, we realize this is a potential problem, but it's been looked at and it's been cleared, so you can skip this particular visit." So it's just a way to be a good safety net from a billing and, uh, appointment scheduling standpoint.

Speaking of the scrubber program, just to be a little tactical here, um, how do you act- how does that work? Uh, you have built many things that catch from underpayments to denials of prices.

Um, what does the operation look like day-to-day?

So the scrubbers are automated checks, uh, of, of the database.

It's, uh, it looks into appointment scheduling, charge entry, looks at, uh, techs that do workups, uh, looks at all sorts of areas in the s- in the, uh, database of our EHR.

Every night we have SQL code that investigates the data based on what we've built over the years.

Uh, oh, and it, we-- This has been a seven-year process.

It started with just a few lines of code, and it's expanded over the years.

But, uh, it runs this code every night that, uh, uh, based on the language that we set up.

When we first started doing it, we started really just basic ideas.

Uh, what are the most common easy mistakes that might happen? And let me just say this, I'm-- when I'm talking about mistakes, our practice, we see 300 patients a day, and staff are gonna make mistakes.

I expect that.

I don't have, you know, the per-perfection is just not, uh, attainable.

But what we're, we started with, what are some of the, uh, headaches that we deal with? What are some of the things that are easy fixes? And, you know, if we didn't schedule a follow-up...

So with retina injections, there's, uh, they had to be at least 28 days out.

Uh, and if we, if somebody at the front desk scheduled something within that 28 days, I wanted the supervisor to get an email that said, "Hey, this happened.

Uh, we might want to, you know, you might wanna take a look at it." Another example, if the coders actually put in the wrong number of units for a procedure, such as a J code for medication.

And so, uh, one, once we built that, then we were, uh, kinda getting off onto the, it, it, uh, it turned into show and tell.

I'd be like, "Hey, look, here's something that we've been able to build on the billing side," or, "Here's something we've been able to build on the appointment side." A-and so it's built, it's grown from there.

When we create them, I typically, uh, have the person who saw the issue or identified the problem join in a conference call with our SQL programmer and me, discussion of what happened, what we're trying to avoid going forward, and how we can isolate the problem.

Um, our e- department heads w- or, uh, department supervisors will get these, uh, scrubbers every day.

Other scrubbers that we build go to different personnel to monitor those areas.

Uh, the recipients will look at these flagged emails, and if it's, you know, it's a problem, oh, we scheduled a, a person under 16 years old for a doctor who doesn't see kids, you know, we g- we handle it.

If it's a billing issue, our coders will rebill as needed.

If, for example, it's a false positive situation where if they, if we did bill a second injection within two weeks, but it's just patients coming back for the other, for the opposite eye, what we do is we have a- All clear code for that particular visit.

So the, that will tell the PM, the practice management software, "Okay, we realize this is a potential problem, but it's been looked at and it's been cleared, so you can skip this particular visit." So it's just a way to be a good safety net from a billing and, uh, appointment scheduling standpoint.