4 Steps to Transplant Program Financial Optimization
Transplant programs are complex and highly specialized, requiring seamless coordination between clinical care, administrative teams, and financial operations. Optimizing the financial performance of your transplant program can increase revenue, streamline operations, and enhance patient outcomes. Below are four practical steps to optimize the financial health of your transplant program.
1. Improve Bundled Billing and Global Authorizations, Reduce Denials
Transplant programs often face complex payer requirements, leading to an increased risk of claim denials. Ensuring that transplant related claims, if necessary, are held in order to be bundled, or sent to transplant specific coverage can be a taxing process on billing personnel if bundled billing workflows are not created. Creating transplant specific workflows with key touchpoints to denote transplant encounters is a great way for staff to maintain efficiency, organize transplant related care for further reporting, and facilitate clean claims leaving the hospital in a timely manner.
A cohesive transplant referral process is essential for providing care access to patients in a timely manner, as well as accurately reporting data to entities like UNOS and SRTR. Actions such as referral triage, and referral auto linking can keep patients moving through the healthcare system expeditiously. Keeping transplant episode creation and evaluation starts within the transplant program workflow allows for more control, and more accuracy in the data being shared with these agencies.
Epic provides powerful tools to track, manage, and resolve claim denials effectively. Epic Resolute and Epic Claims Management allow for streamlined denial workflows, tracking root causes, and automating corrective actions. By analyzing denial trends within Epic, you can address coding errors, incomplete documentation, or payer-specific issues quickly, minimizing delays in revenue collection and preventing future denials.
Key Actions:
- Identify common denial reasons and address them systematically.
- Collaborate with billing teams to ensure accuracy.
- Establish a two-step referral process for more accurate reporting of transplant referrals and evaluations.
2. Leverage Technology for Efficiency
Optimizing your transplant program’s financial performance requires leveraging technology to its fullest potential. Epic Phoenix, for example, provides specialized tools for transplant programs, helping streamline everything from donor and recipient tracking to financial reporting. Regularly evaluate your current systems and ensure that you’re using the full capabilities of your EHR, billing system, and reporting tools to automate processes, reduce manual errors, and improve workflow efficiency.
Integrated workflows can be built within Epic and tailored to optimize your transplant program’s financial processes. Unfortunately, this is not a part of Epic’s out-of-the-box product–it will need to be built by an Epic Transplant Expert.
Key Actions:
- Ensure Epic Phoenix and other systems are fully integrated into your financial workflows.
- Automate processes where possible to reduce manual intervention.
- Use Epic reporting tools to track financial and operational performance.
3. Conduct Regular Financial Audits and Reviews
Frequent financial audits can uncover inefficiencies, missed revenue, and areas for improvement within your transplant program. By reviewing financial reports regularly, you can ensure that charges align with services rendered and detect any potential compliance issues. Focus audits on key areas like transplant-related charge capture, payer reimbursements, and patient financial responsibility.
Key Actions:
- Schedule quarterly or bi-annual audits of transplant program finances.
- Review payer contracts to ensure proper reimbursement rates for transplant services.
- Identify and address any discrepancies in charge capture and billing.
4. Build a Culture of Financial Accountability
Ensuring the financial success of your transplant program requires a culture of accountability across all teams, from clinical staff to administration. Provide ongoing training for staff on the importance of accurate authorization documentation, coding, and billing processes. Foster open communication between departments, and assign a transplant point-of-contact in departments that interact with the program frequently, to address issues proactively and maintain focus on financial optimization goals.
Key Actions:
- Implement regular training on authorization documentation, coding, and billing for all relevant staff.
- Create financial performance metrics and track progress toward goals.
- Encourage cross-departmental collaboration to solve challenges and share insights.
Optimizing the financial performance of your transplant program is a multi-faceted effort that requires coordination, technology, and continuous improvement. By streamlining authorization documentation, improving denial management, leveraging technology, conducting audits, and fostering a culture of accountability, your transplant program can improve both operational efficiency and revenue performance.
For further assistance, Revigate offers tailored consulting services to help hospitals optimize their transplant programs, ensuring long-term financial success and improved patient care outcomes. Reach out today to learn how we can support your program’s financial optimization.
