About Central Vermont Medical Center
Central Vermont Medical Center (CVMC) is the primary health care provider for the 66,000 people that live and work in Central Vermont. CVMC’s outpatient rehabilitation services include an office at the main campus and 3 satellite clinics in the surrounding communities. Prior to implementing MediLinks, CVMC started to look for ways to improve their outpatient rehabilitation business and clinical processes. The MediLinks Solution for Outpatient enabled CVMC to address several of the challenges they identified.[VF1]
The Billing Process Contributed to Errors[VF2]
The former system for capturing charges consisted of the therapist writing the charge codes next to the patient’s name on the same paper that contained their daily schedule. This paper was then submitted to a member of the front office staff at the end of the day for the charges to be manually inputted into their billing system.[VF3]The hustle and bustle[VF4] of the day would often result in the therapist forgetting to write down the charges, carelessly[VF5] write an incorrect charge for the treatment given, or failure to accurately recall from memory the treatment rendered and the accurate charge assigned to the treatment.[VF6]
These problems were compounded further by errors made by the front office staff that entered these charges for the therapist. They would sometimes misread the written charge and enter in wrong information or just mistype the charge altogether. “Overall, there were lots of areas for errors to occur that resulted in lost revenue” as stated by Robert Patterson[VF7], Director of Rehabilitation Services at CVMC. Furthermore, there was no effective system for to ensure proper coding of modifiers. If a charge was submitted without the correct modifiers, the billing department would try to track down the paper chart, look for the documentation that would clarify or support the charge in question, and then resubmit the claim.[VF8] Often times, the questionable charge was just thrown out altogether if the billing department did not have the time or ability to clarify it.
Poor Authorization Management Led to Denied Claims
CVMC had a very good[VF9] process at for obtaining the initial authorization to treat their patients. However, the facility relied almost solely on their busy therapists to track how many authorized visits were remaining for each patient. According to Patterson, “Prior to MediLinks, tracking authorizations involved a lot of guess work and depended totally on the therapist’s ability to manage the process.” Because the visits were not being accurately tracked, CVMC often billed for services they were not authorized to perform, resulting in a fair amount[VF10] of denied claims.
The MediLinks Outpatient Solution
In 2009, Central Vermont Medical Center implemented the MediLinksOutpatient Rehabilitation Solution. MediLinks helped CVMC address many of the challenges it was facing.
MediLinks enabled CVMC to combine the charge capture and documentation process, resulting in improved charge capture[VF11]. The hospital’s Chief Operating Officer, Nancy Lothian, reported, “MediLinksremoves the ambiguity that a therapist may have had prior to using this tool. When they document the treatment, the bill goes out.” Having the charges captured through the documentation process also eliminated transcription and transposition errors that occurred when entering the charges into the billing system. Lastly[VF12], it streamlined the process, eliminating time-consuming, manual steps that the front office had to perform.
Additionally, the MediLinkssolution enabled the therapiststo correct coding errors when they are were entering the charges. Now, instead of having to hunt down the correct charges in the paper chart, the therapist is automatically prompted to resolve the coding issue before the charge is even submitted to billing.[VF13]
Using MediLinks, the therapists have been able to “set up alerts to notify (them) when they needed an authorization for additional patient visits,” reported Patterson. [VF14]Since these additional authorizations were acquired, there have been fewer denials by the insurance companies for these additional visits, allowing CVMC to get paid what they ought to.[VF15]Over the past year that MediLinks has been implemented, CVMC has seen a dramatic financial improvement, yielding a 20% increase in their revenue. [VF16]
[VF1]This feels a bit out of place and also vague. The last sentence is less about CVMC and more about The MediLinks Solution.
[VF2]The subtitle is confusing…and not very compelling
[VF3]This language is too complicated. I think there are simpler and clearer ways to describe the problem. It also sounds too much like a sales sheet and less like a story.
[VF4]Unless it’s a direct quote, idioms/slang should be avoided.
[VF5]“carelessly” is very accusatory, I think we should be more careful with how we describe this. We should be more sympathetic with the therapists and the challenges they face.
[VF6]This a very long sentence that can be broken up. It needs to be simplified for clarity and conciseness.
[VF7]This phrasing distances Robert Patterson from the story…the quote can be incorporated into the story more seamlessly.
[VF8]Very confusing.
[VF9]“very good” is very subjective
[VF10]Fairly subjective
[VF11]Revenue?
[VF12]“lastly” feels out of place when the following paragraph begins with “additionally”
[VF13]Tenses keep shifting
[VF14]Can we clean up this quote?...maybe get it as a complete sentence instead of a fragment?
[VF15]Language feels a bit clumsy here.
[VF16]Isn’t this the lead? It’s buried deep…