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Revenue Cycle Trends To Watch This Year

Posted on July 13, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Revenue cycle management is something of a moving target. Every time you think you’ve got your processes and workflow in line, something changes and you have to tweak them again. No better example of that was the proposed changes to E/M that came out yesterday. While we wait for that to play out, here’s one look at the trends influencing RCM strategies this year, according to Healthcare IT leaders revenue cycle lead Larry Todd, CPA.

Mergers

As healthcare organizations merge, many legacy systems begin to sunset. That drives them to roll out new systems that can support organizational growth. Health leaders need to figure out how to retire old systems and embrace new ones during a revenue cycle implementation. “Without proper integrations, many organizations will be challenged to manage their reimbursement processes,” Todd says.

Claims denial challenges

Providers are having a hard time addressing claims denials and documentation to support appeals. RCM leaders need to find ways to tighten up these processes and reduce denial rates. They can do so either by adopting third-party systems or working within their own infrastructure, he notes.

CFO engagement

Any technology implementation will have an impact on revenue, so CFOs should stay engaged in the rollout process, he says. “These are highly technical projects, so there’s a tendency to hand over the reins to IT or the software vendor,” notes Todd, a former CFO. “But financial executives need to stay engaged throughout the project, including weekly implementation status updates.”

Providers should form a revenue cycle action team which includes all the stakeholders to the table, including the CFO and clinicians, he says. If the CFO is involved in this process, he or she can offer critical executive oversight of decisions made that impact A/R and cash.

User training and adoption

During the transition from a legacy system to a new platform, healthcare leaders need to make sure their staff are trained to use it. If they aren’t comfortable with the new system, it can mean trouble. Bear in mind that some employees may have used the legacy system for many years and need support as they make the transition. Otherwise, they may balk and productivity could fall.

Outside expertise

Given the complexity of rolling out new systems, it can help to hire experts who understand the technical and operational aspects of the software, along with organizational processes involved in the transition. “It’s very valuable to work with a consulting firm that employs real consultants – people who have worked in operations for years,” Todd concludes.

Hospitals Still Grappling With RCM Tech Infrastructure

Posted on May 18, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While revenue cycle management isn’t the sexiest topic on the block, hospitals need to get it right or they won’t be able to pay their bills. One key element needed to accomplish this goal is a robust tech infrastructure that helps RCM specialists get their job done.

However, it seems that many hospitals are struggling to manage RCM data and pick out the right vendors to support their efforts, according to a report published by Dimensional Insight in collaboration with HIMSS Analytics. To conduct the research, the two organizations reached out to 117 senior-level decision-makers in hospitals and health systems.

According to the survey, more than two-thirds of health systems use more than one vendor for RCM. But that might be a bad idea. The research also found that organizations using more than one RCM vendor seem to face bigger issues with denials than those using only one RCM solution. Regardless, the execs said that denials were the biggest RCM challenge for health systems today.

Pulling together RCM data is a struggle too, respondents said. More than 95% of health systems reported that the way data is collected is a challenge. Also, nearly all respondents said that collecting RCM data from disparate sources is also difficult.

One reason why it’s tough for hospitals to put effective RCM technology in place may be that health information management directors and managers aren’t at the top of the influencer list when it comes to making these decisions.

When asked who the key stakeholders were in RCM. 91.5% said that the CFO was the most important, followed by the head of revenue cycle, who was ranked as important by 62.4% of respondents. Meanwhile, only 48.7% of respondents saw the health IT leaders as key stakeholders in the RCM environment. In other words, it looks like tech leaders aren’t given much clout.

When it came to technical infrastructure for RCM, respondents were all over the map. For example, 34.5% were working with an EMR and 3+ vendors. Another 12.1% used in EMR with one vendor, followed by 11.2% with 3+ vendor solutions, 6.9% using an EMR plus two vendors and 4.3% using two to vendor solutions. Clearly, there’s no single best practice for managing RCM technology in hospitals.

Not only that, some hospitals aren’t doing much to analyze the RCM data they’ve got. According to the survey, 23.9% said that 51 to 75% of the RCM process was automated, which isn’t too bad. However, 36.8% of hospitals reported that less than 25% of the revenue cycle process was driven by analytics. Also, roughly a third of respondents said that collecting data from diverse sources was extremely challenging, which can cripple an analytics initiative.

Taken as a whole, the report data suggests that hospitals need to improve their RCM game dramatically, which includes getting a lot smarter about RCM technology. Unfortunately, it looks like it could be a long time before this happens.

When Hospitals Leak Money

Posted on October 20, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A couple of weeks ago I was skimming healthcare business headlines and stumbled across this guaranteed showstopper: You’re probably leaving $22 million on the table. That headline is from a column by Jim Lazarus, who works in the Advisory Board’s Revenue Cycle Solutions division. In his column, he named four ways in which hospitals could recapture some of this lost revenue.

In the article, Lazarus notes that hospitals aren’t following best practices in four key areas, namely denial write-offs, bad debt, cost to collect and contract yield.  Unsurprisingly, Advisory Board benchmarks also demonstrate that median performing organizations are having trouble reducing net days in accounts receivable. The Advisory Board has also found that the overall average cost to collect has worsened by 70 points of net patient revenue from 2011 to 2015.

To turn the stats around, he suggests, hospitals should focus on four critical issues in revenue cycle management. They include:

  • Preventing denials rather than responding to them. “Hospitals are losing, on average, five percentage points of their margin to underpayments, denials and suboptimal contract negotiations,” Lazarus writes.
  • Collecting more from patients by improving their financial experience. According to Lazarus, between 2008 and 2015 the portion of patient obligations being written off as bad debt has climbed from 0.9% to 4.4%. To boost patient collections, hospitals must offer price estimates, convenient payment methods and a positive care encounter, he says.
  • Being sure not to take a hit on MACRA compliance. See that doctors, including those coming on board as employed physicians, get up to speed on documentation performance standards as quickly as possible.
  • Building the value of merged RCM departments. If multiple RCM organizations are being integrated as part of consolidation, look at ways to improve the value they deliver collectively. One approach is to create a shared services organization providing a common business intelligence platform across entities and service lines systemwide.

If you’re an IT leader reading this, it’s probably pretty clear that you have a substantial role in meeting these goals.

For example, if your hospital wants to lower its rate of claims denials, having the right applications in place to assist is critical. Do your coding and billing managers have the visibility they need into these processes? Does senior management?

Also, if the hospital wants to improve patient payment experiences, it takes far more than offering a credit card processing interface to make things work. You’ll want to create a payment system which includes multiple consumer touch points and financing options, which is integrated with other data to offer sophisticated analyses of patient payment patterns.

Of course, the ideas shared by Lazarus are just the beginning. While all organizations leave some money on the table, they have their own quirks as to why this happens. The important thing is to identify them. Regardless, whether you are in RCM, operations or IT, it never hurts to assume you’re losing money and work backward from there.

American Health Network Reduces Denial Management Time by 75 Percent, Realizes ROI of 200 Percent

Posted on August 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Ever since I first attended HFMA’s ANI conference, I’ve been fascinated by the opportunities available in managing a hospitals revenue. There are so many areas where even a small change to your operations directly effect your bottom line. That’s the beauty of any revenue solution.

Thus, I was quite interested to read this whitepaper about American Health Networks experience reducing claim denials. American Health Networks realized an ROI of 200 percent and recovered $1.4 million by changing their denial management practices.

I especially like how American Health Networks chose to roll this out first as a pilot program to a small subset of doctors. Then, after evaluating the results they chose to roll it out to the whole organization. Far too often I see organizations try to go all in with a solution and then fail miserably. There’s a lot of value of rolling out any IT solution to a small set of engaged users before applying them to the whole organization. One of the biggest values of this is the pilot group of users becomes the product champions once you’re ready to roll it out to the whole organization.

There are a lot of places where revenue is figuratively leaking out of healthcare organizations. For many organizations, claim denials is one of those places. I’d love to hear what solutions people have implemented to address claim denials in their organizations.