Revenue Cycle Management

KPG Newsletter -  Info You Can Use Today
September 2016

Kathy Puziak PMP CMPE

  The Power of Automation is at Your Fingertips
by Kathy Puziak CMPE PMP

Sometimes technology and change can be intimidating. How many times have you seen a new product rolled out at work, wholesale change driven and then...within years, the organization steps away from the latest whiz bang solution, reverting to the "old way"? You can rest assured that this is not the case with automation in the revenue cycle. In fact, in these times of shrinking IT staff, growing security requirements, and the proliferation of automated tools, a great integrator and partner may be the answer to optimize results.
Automation is powerful and can truly be a friend to shrinking staff and ever-increasing demands from government mandates, payers and more importantly, quality care. When you take a 360 o view of the revenue cycle and look for opportunities to improve processes thru automation, from that first point of patient contact thru to final payment, you will be amazed and your staff will be energized by the opportunity to get back to patient delivery!

Start with that first point of contact cited above - what tasks can be automated and efficiency improved? Eligibility springs to mind. Eligibility is one of the top 5 reasons for denials and provides a ripe opportunity to impact the bottom line.

Let's look at another area that can be labor intensive, cause delays in claim submission and result in rejections and denials. That's right - coding and charge entry. Many new tools are available to lighten the load - RcXRules and Hosted Claims Manager are two of them. The key is to make automation work for you.

Don't forget that Centricity Group Management (also known as GPMS, Groupcast and CGM!!!) has special programs and functionality that help you automate processes and relieve staff time to do what machines cannot do! It is impossible to list all of the special programs available within CGM, but the ability to automate the claims process is a high priority for many of our group and practice clients.

Sometimes it boils down to a review of how you are using the system modules and thinking outside the box. Using Account Collections to manage patient refunds? We have clients doing just that. Using Task Management to work denials and manage write-offs thru special programs? Absolutely. If you have thought it (or wished you had), it probably can be done! It's time to dust off the pen, sketch out your revenue cycle, look at who is doing what and where  the repetition and inefficiencies lie, and what is not getting done due to staff limitations, whether they be skill or manhours. Then, ask yourself, CAN THIS BE AUTOMATED?

Think automation to:
  • Verify eligibility
  • Reduce rejections and denials
  • Accelerate the claims process 
  • Improve your revenue cycle
  • Realign staff to higher value tasks
...and so much more!


Notes in Group Management  
Part 1 in a Series on Notes
by Ellen Jakovich, 
Director of Training, KPG RCM 

Centricity Group Management Comments and Notes1

  Any user familiar with Centricity Group Management (CGM) can tell you that CGM has many areas that are   utilized for storing notes or commenting on a Patient's account. But not all of them will agree on the best place to document information or issues that may require follow-up at a later date.

Today we begin a series of articles on the Comment sections that will define the information to be collected and the best area to store it. In each section we will provide examples of best practices for ease of use to follow-up on an account, regardless of the data you seek. Having a standard for notes will afford users the confidence of knowing where to look when hunting for documentation and that the information is compliant with the Health Insurance Portability and Accountability Act (HIPAA) and any other government mandates.


  Documenting patient information in the Revenue Cycle system is just as important as the information that is stored in a patient's electronic medical record. Any notes or information must meet HIPAA compliancy and must be in an area that users can find at a moment's notice. This may be tricky for our clients that have been on the CGM system for many years and are accustomed to storing data "where they always have". Let's take a walk together through the comment areas of the CGM system and the best use of each of them.
As we begin this journey, take a moment to look at your practice, check where notes are stored and if your users are able to find information quickly, if needed. Also, objectively assess whether you are meeting all legal requirements. Have you reviewed any of these areas lately?
  •  Are you still storing information in Patient Notes?
  • When was the last time you reviewed your Short/Long questions in Comments and are they still in use? Are you storing information that needs to be attached to a claim? When was the last time you checked to be sure the information was going out with the claim?
  • Are you storing free text information that is not easily interpreted?
  • If the information is related to a specific charge, where is it stored?
  • If the note is about the account balance, where is it stored?
  • Are your notes date, time and user stamped?
Once HIPAA was enacted in 1996, and with its subsequent modifications over the years, it was no longer compliant to delete or erase any information stored on a patient's health record. As HIPAA evolved over the years, CGM also evolved and was updated to assure your continued compliance with the Act. The creation of coded notes was an innovation that fulfilled the requirement for all notes to be electronically stamped with time, date and user name.
The links below will lead you to everything you need to know about HIPAA and what it takes to maintain compliancy with the Act.  As we progress through this series, we hope your newly-gained insight will help your organization meet the needs of your users while remaining compliant with HIPAA mandates. 
 Is RCM ToGo an ASP or is it Cloud Computing?  
by Dave Smeltzer,
Vice President, RCM ToGo, LLC

It turns out it can be either one, depending on the definition you accept. An Application Service Provider (ASP) is a company that provides access to hosted programs, usually over the internet, allowing an individual or organization to utilize a software application. At RCM ToGo, we provide access to, among other things, Centricity Group Management, Analyzer, Infomatics and SQL reporting. The concept of Cloud Computing is a little broader and encompasses several different models; among these are IaaS, PaaS and SaaS. 
Infrastructure as a Service (IaaS) focuses on giving access to the hardware-related aspects of a platform. An example of IaaS is Amazon Web Services. From Amazon: "Amazon Web Services (AWS) is a secure cloud services platform, offering compute power, database storage, content delivery and other functionality to help businesses scale and grow." For example, if you needed to set up a database to track specific metrics, AWS would allow you to do this.
"Platform as a Service (PaaS) is a category of cloud computing services that provides a platform allowing customers to develop, run, and manage applications without the complexity of building and maintaining the infrastructure typically associated with developing and launching an application." Microsoft Azure is an example of PaaS. More robust than a typical IaaS, these services also usually provide a suite of tools along with the infrastructure to facilitate your application development and connectivity.

Finally, that brings us to Software as a Service (SaaS). "Software as a Service (SaaS) is a software distribution model in which a third-party provider hosts applications and makes them available to customers over the Internet."

While RCM ToGo offers many of the services above, and goes beyond hosting, hosting is at the core of what we do. For more information, you can reach me at (630) 391-4778.