How SSI Analytics Became Part of Nebraska Medicine’s Winning Team

Nebraska Medicine Hospital building photo

A Commitment to Excellence
At a time when patient engagement and patient outcomes are critical priorities, the revenue cycle management team at Nebraska Medicine is acutely aware of how their role impacts those they serve. The health network as a whole – the most comprehensive and esteemed in the Omaha region – is committed to transforming lives through premier educational programs, innovative research and extraordinary patient care. With such a commitment to excellence, it comes as no surprise that their mission is reflected in nearly every detail and department within the organization.

Executive Director of Revenue Cycle, Jana Danielson, MS, FHFMA, sets the bar high for her team, but with good reason. By optimizing revenue and allocating resources to the most critical activities within the department, the volume and quality of patient care is elevated throughout the organization as a whole. With these objectives constantly top of mind, Jana and team, led by Stacie Adcock, Revenue Cycle Administrative Services Manager, are always on the hunt for new ways to streamline and strengthen their revenue cycle processes.

Instant Access for Nearly Instant Approval
In December of 2017, Nebraska Medicine began exploring the potential of The SSI Group’s analytics solution. The health system is a progressive organization – they are Epic users, HFMA MAP App subscribers and users of other business intelligence software.  Even so, given the longevity of their relationship with SSI, combined with their constant quest for revenue cycle improvement, they enthusiastically agreed to a product demonstration.

Once Nebraska Medicine got a glimpse of SSI Claims Analytics, the speed of the application was quickly identified as a positive. As they quickly discovered, the solution offers instant access to claims-related data in a responsive, one stop shop, user-friendly format. With Stacie’s endorsement, Jana was quickly brought into the discussion to provide high level consideration of the product’s potential to transform their facility. “What we noticed was an ability to get to the level of detail necessary for process improvement, all in one precise location,” stated Jana. “The information is at your fingertips, which allows users to quickly and easily compare items or drill down to look at specific payer detail.” The health system was also impressed by the ability to drill down into their clean claim rate to identify problem areas, along with the ability to capture both professional and hospital components in a single view.

Reliable Vendor, Responsive Solution
Given the sheer financials of where many facilities are today, especially large health systems like Nebraska Medicine, it is nearly impossible to accomplish organizational objectives without bringing in sufficient revenue. Quick turnaround, low denial rates, prompt payments, quick and accurate payer collections – these items are imperative to sound financials and, ultimately, exceptional patient service.

Sometimes you don’t know what you need, or want, until you see it. Once Nebraska Medicine was aware of the functionality and availability of SSI Claims Analytics, they knew they could benefit from a solution of this sort. Already an SSI Billing and Eligibility client, the organization prefers to stick with SSI when possible, due in large part to a superior level of service, a willingness to listen to clients, and a tendency to offer suggestions for best practices. Product and vendor combined, SSI Claims Analytics proved to be the right solution at the right time for Nebraska Medicine.

Implementation: Along for the Ride
At most large health systems balancing limited resources and competing priorities, staff in today’s healthcare landscape simply don’t have the bandwidth for a cumbersome implementation process – which is usually how a new software roll-out unfolds. Thankfully, since SSI already had access to Nebraska Medicine’s data, implementation turned out to be a non-issue for the facility. As Jana commented, implementation was “quick and painless…the level of effort on our part was minimal. We sat back, smiled and were along for the ride.” Had the implementation required significant resources on the organization’s end, they likely would not have pulled the trigger as early as they did.

A Proactive Approach to Revenue Cycle Practices
After using SSI Claims Analytics for just 90 days, Nebraska Medicine immediately began to reap the benefits. With meaningful data now at the touch of a fingertip, they were able to drive workflow improvements and, in doing so, increase efficiency throughout the department. In addition to reclaiming and reallocating resources – including one full FTE – by eliminating manual processes, they were also able to adopt a more proactive approach to revenue cycle practices. Using the application, they can identify when something important, such as a payer issue, is creeping up and take the steps necessary to handle it immediately rather than waiting for a user to be alerted of the issue via a follow-up queue.

Today, Nebraska Medicine harnesses the power of SSI Claims Analytics in a variety of ways: to establish informed payer conversations, streamline workflow, monitor clean claim and denial rates, and ensure they’re getting paid timely and accurately.

Denial Drill-Down
From a denials perspective, the organization can now dive into their data to get information on first pass denials, line item denials and other items that enable them to evaluate how their payers stack up. Armed with granular data on denials, they’ve also been able to engage in more informed conversations internally. For instance, the hospital’s senior-level executives recently became concerned about their denial rate “skyrocketing”. Using data from SSI Claims Analytics, Jana was able to drill down, even by payer, to first pass denial rates, partial denial rates, etc. to provide a more accurate picture of the situation and explain that perception was not reality.

Shifting the Focus – and the Needle
Nebraska Medicine’s clean claim rate was good to begin with, but their revenue cycle team had their sights set on moving the needle even further. In examining the statistic, they learned how SSI Analytics could help guide users to ask the right questions and hone in on the right priorities, rather than focusing on an item that would ultimately prove to be less impactful. For example, in a payer breakdown, it appeared that they should focus their improvement efforts on one particular “problem” payer whose clean claim rate was about 10 points lower than its peers. By pulling data, they soon realized this payer wasn’t a significant concern from a volume perspective, and that it would have more of an effect to look at the organization’s biggest payer because who was pulling the most weight. Thanks to these capabilities, combined with their diligence, Nebraska Medicine’s clean claim rate continues to climb.

“Even aside from the clean claim rate, it’s just good to have everything in one place,” mentioned Jana. “You can see your paper claim percentage. So if, for some reason, we started to see that go up then we’d ask the question, ‘Do we not have our payers set up appropriately?’ Whereas historically, it would be, ‘We’re getting all these paper claims printed and we’ve seen it for two or three weeks. Can someone tell us what’s going on?’ ”As Stacie reiterated, “We don’t have to wait for an end-user to report [an issue], we can find it ourselves.”

Continuing to Push Performance
With continued use of SSI Claims Analytics, Jana and team are looking forward to the opportunity to strengthen their revenue cycle processes – and their organization – even more. With nearly instant access to their data, they hope to initiate more candid conversations with payers about their performance in light of their peers and to push payers, from a contracting perspective, by being able to determine how payers’ actions affect them in both the short and long-term.

As a competitive organization and department, they also hope to more fully utilize the solution’s benchmarking functionality so they can begin to thoroughly evaluate critical items against themselves and others. “We want to make sure we’re not at the bottom of the pile,” said Jana. “If we are, we need to be able to dive into what it is we need to fix to get us to where we need to be.”  At the end of the day, Nebraska Medicine is focused on excellence and, with SSI’s help, they’re confident they can achieve it.

About Nebraska Medicine:
Nebraska Medicine is the most esteemed academic health system in the region, consisting of 809 licensed beds at its two hospitals, more than 1,000 physicians and 40 specialty and primary care clinics in Omaha and surrounding areas.

Nebraska Medicine and its research and education partner, the University of Nebraska Medical Center (UNMC), share the same mission: to lead the world in transforming lives to create a healthy future for all individuals and communities through premier educational programs, innovative research and extraordinary patient care.