MetahOS Helps Reduce Accounts Receivables for Hospitals

MetahOS - Finance Head

The revenue cycle is the central nervous system of any healthcare enterprise. It communicates and coordinates information about the system’s most important relationship with Patients, Providers, and Payers. An integrated revenue cycle will help healthcare systems strengthen these relationships. MetahOS Helps Reduce Accounts Receivables for Hospitals. 

What Are Accounts Receivables (A/R)?

Accounts Receivables are simply money that has already been earned but not received by hospitals when a hospital bills its insurance companies (payers) for treating their subscribing patients, resulting in outstanding payments owed to the hospital by the payers.

Who are these Payers?

These Payers typically are:

  • Private Insurance Companies: Bajaj Allianz and any other Health Insurance Companies
  • Corporates & MSMEs: Industries, Railways which contract a hospital to provide care to their employees
  • Government Schemes: Employee State Insurance (ESI), ECHS, Ayushman Bharat, Arogya Bhagya, and countless other state and central government schemes.

Understanding Your A/R Report

A hospital’s Accounts Receivables report lists all inpatient and outpatient services rendered to patients during a given period. These reports are used to determine how much a patient owes the hospital for services and/or supplies. 

A mid-size hospital’s A/R is typically 1-year of EBIDTA, and, in some cases, it might go up to 2-years of EBIDTA.

Root Cause Analysis: Why Does A/R Increase?

An increase in Accounts Receivables starts when the patient is admitted and multiplies each day for every mistake across the patient journey. Most often, the delay in Receivables is due to lapses at the Hospital end.

 

Metahos Healthcare Operating System Integrated Receivables Management System Increase in Accounts Receivables

Below are the 6 common root causes of delay in A/R

  1. Patient Admission/Registration

    1. Unavailability of Patient Checklist for Eligibility
    2. Efficient Screening Process
    3. Staff Training Issues
  2. Ward

    1. Delay in Updation of Records
    2. Incomplete File
  3. Reports

    1. Delay in Radiology Reports
    2. Delay in Lab Reports
  4. Billing

    1. Random Selection of File for Bill Processing
    2. Delay in Investigations Report
  5. Government & Validation Desk

    1. Unavailability of Patient-Centered Counselling
    2. No Requirement to Enter a Discharge Summary
  6. Claims

    1. Absence of Process Monitoring
    2. Shortage of Man Power

How to Overcome These Pitfalls

Hospitals need to bring in change through the following 6 drivers.

  1. Revenue Realization

    • Improve revenue growth by decreasing A/R
  2. Increased Productivity

    • Decrease time taken to submit claims by at least 50%
  3. Service Delivery Improvement

    • Measures to improve the flow of documents between departments
  4. Cost Reduction

    • Reduce cost by enabling single entry, multi-use
  5. Treatment of Operational Risk

    • Reduce PEOPLE dependency; increase PROCESS dependency
  6. Compliance

    • Stay compliant while improving processes, training, and enabling technology

Risk Awareness and How to Mitigate

Knowing your risks is half battle won! As Sun Zhu, the author of Art of War, says, “If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained, you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.

Some of the common risks include:

  1. Systems are not interoperable nor integrated, thereby creating duplicate transactions on multiple systems.
  2. Too much dependency on Human Resources rather than processes.
  3. Unaware of daily vital statistics to the running of a hospital.

Recommendations for Operational and Financial Gains

Identify Bottlenecks and Fix

Like a supply line in a manufacturing company, the files move in a predefined order. Still, every process creates bottlenecks if the implementor does not understand the Theory of Constraints.

Baseline Performance Profile

For consistent data to assess action areas, proceed with data collections, and Revenue Cycle improvement.

IT Optimization

An ongoing process that uses best practices and solutions to remove gaps. Also, initiate Continuous Improvement Process (CIP) and award best practices.

Patient-Centric Revenue Cycle

A Patient-Centric Healthcare System would improve care delivery and provide seamless integration across scheduling, registration, arrival, care delivery, billing, post-care, collections, and be key for revenue integrity & market leadership.

Hospitals can now benefit quickly from MetahOS Integrated Receivables Management System (IRMS), as it can work alongside any Health Information System (HIS). Along with IRMS, you also get

  1. End-to-end transformation

    Deliver comprehensive revenue cycle services, including process redesign, technology enhancement, organizational design, and performance management.

  2. Revenue cycle business intelligence

    Conduct root cause analysis of revenue leakage to identify net revenue, reduce bad debt, and accelerate collections.

  3. Charge integrity and reimbursement

    Drive net revenue improvement through an enhanced mid-cycle process.

    • Meta hOS Accounts Receivables Simplified
  4. Revenue cycle systems implementation

    Plan, design, and implement technology systems.

  5. Revenue cycle tools

    Automate workflow processes and enhance reporting capabilities through IRMS.

Currently, 80% of all Hospitals are not utilizing the power of the Integrated Receivables Management System.
The lack of integrated tools leaves hospitals frustrated with not getting paid on time and with no time to handle their receivables. This is where MetahOS Helps Your Hospitals Reduce Accounts Receivables.

Supporting Patients across Continuum of Care

MetahOS Continuum of Care EMPI

As every healthcare provider knows, each time you conduct a patient encounter, it is important that you gather information about your patient in order to treat them properly. The Enterprise Master Patient Index (EMPI) is the industry’s leading methodology for recording and treating patients with multiple medical needs. EMPI improves outcomes and patient care through seamless treatment of patients across the continuum of medical care while improving efficiency in processes, promoting practice strategy alignment, and improving compliance with individual regulatory agency requirements. EMPI leverages all critical information gathered in the clinical setting including demographics, diagnosis, problem list, medications, procedures performed and more. Using EMPI you can bring all potentially relevant patient records for a given encounter into one place-helping to facilitate delivery of seamless care.

Enterprise Master Patient Index

 

An enterprise master patient index or enterprise-wide master patient index is a database that is used across a healthcare organization to maintain consistent, accurate and current demographic and essential medical data on the patients seen and managed within its various departments. The patient is assigned a unique identifier that is used to refer to this patient across the enterprise. The objective is to ensure that each patient is represented only once across all the software systems used within the organization.

 The essential patient data includes name, gender, date of birth, race and ethnicity, Aadhar number, current address and contact information, insurance information, current diagnoses, most recent date of hospital admission and discharge (if applicable), etc.

EMPIs are intended to solve the common problem where multiple systems across the organization gradually become inconsistent with respect to the patient’s most current data when the patient’s information changes, and only one system is updated, i.e., the changes are not propagated to others.

 

Key Identifiers

Last Name, First Name

Date of Birth

Administrative Sex

Address

Types of patient identification problems that compromise the integrity of the EMPI typically fall into one of the following categories:

  • Duplicates: Two or more medical record numbers for one single patient.
  • Overlays: Two or more patients are assigned one record number.
  • Overlaps: Patients seen at multiple facilities have overlapping medical record numbers at each facility within an enterprise or integrated delivery network.

The EMPI is adaptable to a variety of healthcare architectures, including Health Information Exchanges the others. 

EMPI services should include:

    • Data Cleansing
  • Data Normalization
  • Data Standardization
  • Recognize at all points of service
  • Improve quality of care by accurately locating and linking demographic information
  • Improve clinician satisfaction by providing more trusted and accurate patient identification at the point of service
  • Quickly create applications powered by patient data that can be used to solve standalone problems or can be embedded into existing applications

Build a foundation for growth with a highly scalable solution that can be extended to include a single view of providers, healthcare organizations, etc.

Approach:

  1. Business Process Understand the business processes and existing infrastructure
  2. Training  Train the users / developers on how to use or build an EMPI system
  3. Technology Work with existing technology or provide a framework to establish query response with the EMPI engine

Algorithms and Identifiers:

EMPI needs to use various algorithms to establish a single patient index, the most frequently used and the one that we recommend is levenshtein, also along with the algorithm there needs to be a an identifiers setup which will determine and index the patient.

Jaro Winkler: https://en.wikipedia.org/wiki/Jaro%E2%80%93Winkler_distance

Levenshtein: https://en.wikipedia.org/wiki/Levenshtein_distance

Large number of Small and Mid size Hospitals in India Lack The Basic Hospital Information & Management System

The platform for Small and Mid size hosptials

Small and mid size hospitals today are under tremendous pressure – Too much patient load, not enough resources and a host of information technology issues. They are now looking for ways to make their lives easier without compromising on patient care. MetahOS Healthcare Operating System – Designed by doctors for doctors aims to do exactly that! Today’s healthcare system is heavily dependent on IT and the clinical staff have little say in the way their medical practice runs. It is not uncommon to see dedicated specialist clinicians having to struggle with basic computer administration, software maintenance and internet connectivity. This puts a huge strain on them in their day job, which is already stressful by itself. Smaller hospitals spend most of their revenue on expensive proprietary systems that don’t scale well.

 

Healthcare is an evolving sector

The middle class population is moving towards mid-sized cities with better lifestyle factors like in India region. This gives rise to demand for scalable technology solutions which can be used across the healthcare verticals providing efficiencies and standardisation at regional levels. Having said that, we have launched a Healthcare operating system which will provide a platform for small & mid sized hospitals and providers to adopt and scale up their operations effectively.

In the past few years there has been an increase in the number of hospitals owned by Clinicians and Doctors. This is really good for Healthcare Industry as it has given control in the hands of the people who actually take care of patients on a daily basis. The downside to this trend is that these small and medium size hospitals lack infrastructure, technology and resources to run a hospital effectively. Now MetahOS is addressing this issue by making state of art healthcare operating system available to every clinician across India with a monthly subscription.

What is needed

The small and mid size hospitals need a convenient and simple way to manage their healthcare team, patients, assets all in one place. Many hospitals use paper workflows which result in huge losses of revenue and business opportunities.

At m16labs, we’re excited to announce the launch of our Early Access Program for Meta hOS (Healthcare Operating System). We believe the future of healthcare is digital and cloud connected – that every patient should have a 360 degree view of his or her own health information and clinicians should have the tools they need to deliver safe, high quality, coordinated care.

Contact us

Do check out the paper on poor standard of care in small, private hospitals in Maharasthra by Padma Bhate-Deosthali, Ritu Khatri, Suchitra Wagle.

Health Information Systems are being Phased Out

The Hospital Information Systems a.k.a Health Management Information Systems in India were not built to last for Healthcare, they were ERP’s that were retrofitted to do Order Entry, these Enterprise Resource Planning systems were built for Supply Chain and Manufacturing companies and in the early Digital Transformation 1.0 during 2013 onwards the software companies modified their applications to meet Hospital IT requirements.

This got the hospitals to use the HIS, however they were just using it for order processing and billing and the rest of the features that were built without considerable Healthcare Domain left a bad after taste to Clinicians and also to the rest of the users who were not in Billing.

After working for nearly 2 decades in the US Healthcare IT and interviews with various hospitals and hospital users it was clear that Indian Healthcare IT has not evolved or rather hospitals are now scared to upgrade because of the bitter experience they have had.

The need for a Healthcare Operating System is evident in Indian Healthcare IT, as the industry battles quality of healthcare delivery, availability of trained resources.

The Meta hOS (Healthcare Operating System) built with a lot of due diligence and users feedback is expected to deliver what was lacking in the industry.