Custom Epic Workqueue for AMC

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Situation

Prism has a longstanding partnership with a North Carolina-based academic medical center with $4.2 billion net revenue, over 36,000 staff members and 1,500 physician members. The 1,200+ bed system includes three hospitals, a private diagnostic clinic, university–affiliated physicians and community private diagnostic clinics. The system provides over 60,000 inpatient admissions and over 1.3 million outpatient visits a year.

The AMC manages its revenue cycle through the Patient Revenue Management Organization (PRMO). At the PRMO, revenue cycle leadership oversees many centralized functions for hospital and physician visits, including Pre-Registration, Insurance Verification, HIM/Coding, Billing, Follow-up, Denials and Patient Balances. Most workflows and data are housed in Epic, following AMC’s system-wide conversion to Epic in 2013.

In 2014, one year post-Epic go-live, the AMC was experiencing a growing accounts receivable and identified a need for tools and reporting to effectively manage staff and inventories. Leadership brought in Prism Healthcare Partners for a dedicated A/R clean-up and sustainability engagement.

Solution

Prism developed and implemented a unique workqueue (WQ) tool and process to drive real-time performance management and allocation of resources by leveraging Epic data for key insights into revenue cycle work in process. Prism’s Epic experts helped the AMC:

  • Prioritize staffing by aligning to risk in an Epic environment
  • Gain transparency and visibility into revenue cycle team performance by establishing and monitoring executive-level operational, qualitative and financial metric goals to support cash acceleration milestones and steady state standards
  • Enhance WQ management, including:
    • Reconciling Epic WQ volumes, inflows and outflows to validate coverage and performance levels
    • Deploying a WQ management tool predicated on automated data feeds from Epic, providing management the ability to support and reduce work in process target at-risk A/R populations by Owning Area, Grouper, Supervisor and WQ levels

Sustainable Improvement

Prism provided training and materials to support WQ management, including how to interpret weeks of inventory backlog, at-risk A/R populations and how to align resources and action plans according to weekly trending.

The WQ tool has been in use on a weekly basis since 2015 and is integrated into the weekly process for the AMC’s entire management staff.

Connect With an Expert

Mukesh Gangwal

Managing Director

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John Storino

Managing Director

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