AnMed Health is one of South Carolina’s largest not-for-profit health systems, managing more than 26,000 admissions and almost 100,000 emergency department visits per year. Comprising three Joint Commission-certified hospitals, AnMed Health has been affiliated with Atrium Health, previously Carolinas HealthCare System, since 2009.
In November 2015, AnMed Health engaged Guidehouse to transform and optimize their system in preparation for their upcoming Epic electronic health records go-live. Based on a comprehensive pre-live readiness assessment, AnMed Health decided to prioritize focus on developing a newly centralized professional billing office (PBO) and hospital/professional revenue integrity program — actions that would drive the most effective results in conjunction with the Epic platform.
AnMed Health had to navigate these changes through the following risks and challenges:
Lack of consolidated ownership through previous chief financial officer in both professional billing and patient access, creating a difficult environment to implement change
Resistance to change among staff, management, and leadership
Lack of knowledge around current- and future-state revenue generation associated with the impending Epic conversion
Decentralized physician practices with separate business offices that lacked standard workflows and accountability
Aged legacy systems requiring heavily manual processes and multiple touches per claim
In addition to other targeted initiatives across the revenue cycle, Guidehouse supported AnMed Health through transformational campaigns in the following key projects:
AnMed Health historically used a decentralized, “cradle to grave” professional billing structure across its practices. As AnMed Health prepared for its Epic conversion, the strategic decision was made to implement a centralized PBO where staff would specialize work by function and adapt to fully leverage the Epic platform. Due to both space and timeline constraints, the Guidehouse team developed and oversaw the strategy to consolidate roughly half of the organization’s physician billing practices prior to the Epic go-live.
Revenue Integrity Implementation
In addition to thorough end-to-end testing, Guidehouse partnered with AnMed Health to create a gap analysis between current- and future-state charging workflows, ensuring department owners were aware of current-state charging workflows and how those would change with Epic. Standard policies were created ahead of the Epic implementation so that the organization was prepared for the new rigor and focus. AnMed Health also hired a permanent revenue integrity manager to provide oversight and accountability and help guide the department growth for the future.
Partnering with Guidehouse not only ensured steady cash flow throughout our Epic conversion, we’ve actually seen increased net revenue and operational efficiency in our revenue cycle post-live.
Chief Financial Officer