Fifth Third Bank is addressing critical challenges in revenue cycle management following its acquisition of Big Data Healthcare, a technology solutions provider for healthcare payments and remittance.
In this episode of Healthcare Insider, Dee Harding, Chief Product Officer of Fifth Third and Big Data Healthcare, and Connor Craven, Business Analyst, describe how automation is advancing healthcare finance visibility and accuracy.
Angie Stewart: Hello and welcome to Healthcare Insider, a sponsored content podcast series from Modern Healthcare Custom Media. I'm your host, Angie Stewart.
This episode is sponsored by Fifth Third. Fifth Third is a bank that's as long on innovation as is on history. Since 1858, Fifth Third has been helping individuals, families, businesses and communities grow through smart financial services that improve lives.
On today's podcast, we are thrilled to have Dee Harding, Chief Product Officer of Fifth Third Bank and Big Data Healthcare, and Connor Craven, Business Analyst, joining us to discuss opportunities for healthcare to optimize payments and revenue cycle capabilities. Thank you both so much for being here today.
Dee Harding: Thank you, Angie. It's great to be here.
Connor Craven: Thank you, Angie. It's great to be here as well.
Angie Stewart: Dee, how long have you been doing this work?
Dee Harding: I've been in healthcare for a little over 19 years. I spent the last 14 really focusing on management of revenue cycle and the automation of processes. Really excited to be here today and to share the story and the journey of the automation and how we have seen it evolve over the last few years.
Angie Stewart: And Connor, could you give an introduction to yourself and what you’re excited about for this conversation?
Connor Craven: Yeah. Hi. My name is Connor Craven. I've held various roles between finance and revenue cycle operations, specifically relating to AR related payments and the end-to-end reconciliation of them. I'm excited to just share about the potential of this automation, of the tool of end-to-end reconciliation, and then the potential it can possibly bring to all of you.
Angie Stewart: You both have such great experience to bring to the conversation today, and I'm excited for this discussion. Let's dive in with a level-setting question. What do healthcare revenue cycle capabilities currently look like, and where are the biggest opportunities for optimization? Dee, I’ll field that one to you.
Dee Harding: For years, when it comes to payments and the reconciliation of the payment, either to the 835 or remittance advice or even to a transaction that may need to go to your general ledger account, most processes were very manual. When we talk about those manual processes, you can literally think of it as someone in the hospital system or the provider organization is logging into the bank account and they're pulling down their payments for a given day. That usually travels then to our cash posting teams. And those teams then would funnel through a process where they're going to look at this Excel spreadsheet, and they're going to decide what they can post. So, what has been sent from their clearinghouse, that can be posted into their electronic medical record. It's usually very important for organizations to make sure that money is in the bank before they actually post it.
And sometimes, the only option that the organization has is to manually track everything on a spreadsheet. Sometimes, we see that being put in SharePoint. Sometimes, we even see those organizations that are posting having to go back in and update the spreadsheet for what is posted. So traditionally, we started with very, very manual reconciliation, and we're moving to a more automated world. We kind of have this hybrid approach that's out there as well. Some of the providers are using clearinghouses or even using their electronic medical record to help them reconcile that EOB back or that ERA back to what is in their bank account. We do oftentimes see limitation on that. Sometimes, the clearinghouse or the EMR can only take one bank. Sometimes, they can only take one bank account. So where the industry is moving and what is really exciting in the industry now is we have these portals that really help with the automation of reconciliation.
So this is a one-stop shop where all of your payments, all of your remittances, all of your paper can come into one portal and be visible for you. So essentially, it's a hub for everything to do with anything you need in the cash posting world. Those type of portals that we see out there from an automation standpoint can also usually ingest some payment posting reports from those electronic medical records. So not only are they able to show you what's in your bank account, they can ensure that what you're posting in your electronic medical record is actually what you expect it to be. And if it's not, there are a lot of systems that you can go in and see what do I need to work based upon the input and output of my electronic medical record. And finally, we're seeing some of these automated systems be able to take your non-patient cash and reconcile that so you can actually send reports or send automation into your general ledger to post those transactions as well, and as a last part of the process, reconcile that back to your general ledger.
Angie Stewart: That's a wonderful overview. I'm hearing visibility, accuracy are just a couple of those benefits of automation. I want to shift a little bit to talk about Fifth Third’s recent acquisition of Big Data Healthcare, which is a technology solutions provider for healthcare payments and remittance. Dee, could you talk about the status of this integration and how it's allowing Fifth Third to solve for the challenges in reconciliation, some of the ones that you touched on with your first response?
Dee Harding: Absolutely. The acquisition's been a very exciting experience for all of us at Big Data. From the standpoint of Fifth Third clients, we are integrated, so any Fifth Third client that would need our assistance in any of the services we have today, the data's at our fingertips and we can have that in our system in a matter of business days. I think the biggest thing that the acquisition allowed for was really to keep Big Data’s autonomy. We are fully owned by the bank. We are still able to offer our solutions to everyone in the marketplace. So essentially you don't have to be a Fifth Third client to use our reconciliation services. However, our approach to any client is very consultative. We usually go in and we look at the client and we say, 'What can we help you with today?' And we see a lot of our implementation being phased implementations. So maybe we need to look at the automation of paper. Maybe it's the automation of not just the EOBs, but the correspondence documents. And then maybe we move to the electronic and then move to the end-to-end reconciliation of every single transaction to that bank account. So the acquisition has also allowed for the expansion of all of our product offerings and just really overall having the backing of such a large organization has allowed us to scale and grow and really put the resources in place to be able to handle a large amount of work at one time essentially.
Angie Stewart: So when onboarding a new client, why are transparency and data management important, and what steps do you take to bring those elements to the forefront?
Dee Harding: I think the most important concept to onboarding any client is transparency. We work very, very hard to make sure that our clients know exactly what the expectations are, who's going to do what, the timeframe. So we have, in partnering with the bank, adopted some very unique business control processes. We have a team of folks that ensure that we have all of the right legal documents. And then from the standpoint of the client, what are we actually going to do for you? That client works one-on-one with our product team, and we define that statement of work so that not only the client knows what to expect, but our product experts are the ones setting the stage. So the client also knows, we know that what we have purchased and what our expectations are, are going to be able to be delivered upon. And then after that, we turn to the implementation team.
Our implementation team has many, many years of experience in the healthcare revenue cycle. And I think that's also something that sets us apart is that consultative approach and finding the right people for your team. We want people that have actually sat in that seat of that organization that's coming on board so that we have the best people doing the best jobs for these implementations. So it really just goes back to not only having the business controls in place, but also the ability because our team has so much experience that we can actually be a revenue cycle consultant for you as you are going through your processes to ensure that everything goes as smoothly as possible.
Connor Craven: And I think that really allows for the human interaction piece of it that often gets missed within this world. Having that actual relationship as you're going through this implementation allows for the transparency of understanding, okay, these are the difficulties that the business faces day-to-day. How can they be relieved with this type of software, with this type of product to ultimately drive the results that will provide positive impact for the organization?
Angie Stewart: Thank you. Yes, it's great to hear about that process. And Connor, I would love to tap more into your expertise and extensive experience in the industry. From all this experience, can you share how reconciliation challenges have historically impacted organizations and what were the typical processes before automation became more prevalent like we're seeing today?
Connor Craven: Yeah, so I think there's three different levels that it can be looked at. There's ultimately the preparation piece, which is going into the bank accounts, pulling in those prior day deposits, actually getting the payment information within those specific deposits that is provided to the bank from the payer and/or insurance company, and then putting that in a tool that that organization can allow for their people to go into actually work it. So you ultimately have the data preparation piece, and that's just so that it can be worked. Then you have the actual working piece of it to get it posted within the electronic medical record and then actually doing that in an accurate and timely manner. And then the last level to it would be ultimately that reconciliation piece to verify, 'hey, this has been posted in our system, and we are recording for this correctly from a financial and accounting standpoint.'
So when you look at all of the different jobs that kind of go into it, the biggest one is that preparation piece. So with this type of product and the ability for it, it really cuts all of that manual effort of going into the bank each day, downloading it, trying to put it on your own internal drive, storing of all of that data, and then ultimately just getting it so that somebody can work it. It streamlines that end-to-end piece of it really upstream so that you can say, 'hey, this is what we received in the bank. This is what's posting in our system. Is this reconciled yes or no?' And then, to touch more on that last piece, if it's not reconciled, you have that ability to really analyze and drill into it to say, 'this is why we're not reconciling, and this is a piece of the area that we need to focus on more often than not to make sure that it doesn't happen going forward.'
Dee Harding: Hey, Connor, can you tell us about how long it took or how long it could take an organization just to pull the data down from those manual processes?
Connor Craven: Yeah, so I would say somebody that's experienced anywhere from two to three hours, and then if you get somebody that isn't necessarily as experienced, maybe half of a working day, it really comes down to how many bank accounts you have, how many different lockboxes are you then downloading all of those images for and then saving them to your internal drive. Do you have a larger deposit day on Mondays than you do on Fridays so you can kind of save some of your time? So there's a lot of variables that can go into it when it comes to that manual effort. But with this type of tool in the product specifically, it really allows for you to say, 'hey, this is the allotted time that we expect for these payments to show that at this given moment throughout each working day, let's go tackle them because we know how long this is going to actually take.'
Angie Stewart: Thank you. That was a great point to drill in on, and we hear so much in healthcare about doing more with less. So really taking advantage of this time saving from automation has seemed to be a game changer. Connor, can you share any other ways that the introduction of process automation has really changed the game for organizations?
Connor Craven: Yeah, so it's allowed them to streamline their workflow. That is hands down the biggest game changer when it comes to it. You really get to eliminate that aspect of, 'well, where's my data?' Well, you know where your data is now. It's all in your tool that you have at your fingertips. So from that, it allows you to say, 'okay, here's my data. This is my EMR, obviously let's get it in here, but what does that look like after that fact?' So more often than not, the content that's contained within these EOBs from a nonpayment standpoint, but from a denial standpoint, is ultimately what is going to drive the results of your collections effort that will show a positive impact on revenue going forward. Because you can alleviate those denials from actually having it in the system. So it allows you to really say, 'I have this payment, I have this 835, this is how long I know from when it hits my bank to when it's actually going to be posted in my system.' That way that backend effort can really be driven as soon as possible.
Dee Harding: It's really just leveraging the automation. I mean, for years, we have been telling ourselves that paper is going away, and the statistics that we see in the market now, payers may have become more electronic when sending in ERA, it's no longer an EOB, but the amount of correspondence that a provider is usually overwhelmed with, it's never decreased – it's increased. And that's something we didn't really think we would see in the market over the years. So that's another focus we have is automating even those correspondence documents. So it's really just back to leveraging the automation for every single process in the business office and in the backend of the revenue cycle, and Connor's right – having the visibility into this paper document that someone used to have to look up, they used to have to read and say, 'oh, okay, well this is a medical records request. I better get this to the medical records department.' Being able to apply the automation to that is something we've been focused on and that we're seeing a lot across the industry. It really is helping those denials be managed in a timely manner.
Angie Stewart: Great point. I'd love to take this next question to look ahead for the industry, and I'll start with Connor for the response, but Dee, also feel free to weigh in. What do you envision as the next big steps for optimizing revenue cycle in healthcare, and how are some of these future innovations actually already being implemented today?
Connor Craven: Yeah, so I would say the future of it is really tying together the general ledger from a finance aspect to the financial operation standpoint. So what can get lost in translation nowadays are a lot of those non-AR related payments that can get deposited into those AR accounts that you might not have the visibility with right now while you're working them because you want to get all of this cash into your system and that posting process that a lot of these non-AR related payments that are just as important from your organization standpoint, the visibility. So with that kind of comes the payment I received in this bank account, I was able to do the analysis and the drill down to verify, 'hey, this actually doesn't go into my EMR. Where should it specifically be going in my general ledger?' And then that kind of goes into that automated piece of it, from an export standpoint. This does allow you to load in those types of accounts that link directly to your GL so that when an accountant would be working it or when a cash poster would be identifying, 'hey, there's no 835 for this', it is that one stop like Dee kind of mentioned before to say, 'hey, this is what we’ve got, this is where it needs to go, what is the easiest possible effort that we as an organization can do to get there?' So I would say that's the most exciting piece of it, is just when you really look at what can get lost with all of these different payments, those non-AR related ones that really are centralized more to that true accounting type of work, really are being thought of and ultimately handled properly with little to no effort at all.
Angie Stewart: So we've just heard Connor talking about what we envision as the next big steps for optimizing the future of revenue cycle in healthcare. Dee, do you have anything to add about the work you’re doing?
Dee Harding: Absolutely. If you think about where the industry started from having one to two people download spreadsheets so they knew what was in their bank account or even look in their bank account, to moving to a world where everything is in front of them in one portal. This is the exciting part. This is the part where we can actually say, 'not only are we going to send to your electronic medical record, but we're going to send to those general ledgers, those ERP systems, and we're going to reconcile that.' That's what we're excited about. That's what we've been focused on, and that's where Big Data and Fifth Third Bank is today.
Angie Stewart: Fantastic. Thank you both, Dee and Connor, for this excellent conversation. Really important insights for our audience of healthcare leaders. And thank you again to Fifth Third for their collaboration on this sponsored episode of Healthcare Insider.
To our audience, thanks for tuning in today. To listen to more episodes of Healthcare Insider, go to the multimedia section on ModernHealthcare.com or subscribe at your preferred podcatcher. I'm your host, Angie Stewart. Thanks for listening.
