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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.

Small Financial Innovations that Make A Big Difference for Patients and Hospitals

Posted on May 3, 2018 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.

More and more these days I’m fascinated by the practical innovations that can impact healthcare much more than the moonshot ideas which are great ideas but never actually impact healthcare. I’ve quickly come to believe that the way to transform healthcare his through hundreds of little innovations that will allow us to reach a transformative future.

I saw an example of this when I talked with PatientMatters. They work in a section of healthcare that many don’t consider sexy: revenue cycle management. However, I often say, the financial side of healthcare isn’t sexy, unless you care about money. Given how healthcare is getting pressed from every angle, every hospital I know is interested in the financial side of the equation.

PatientMatters is doing a number of things that are interesting when it comes to a patient’s financial experience in a hospital. They offer a great mix of tools, training, process design, automation and coaching to reframe a patient’s financial experience. This is a trend I’m seeing in more and more healthcare IT companies. It takes much more than technology to really change the experience.

That said, I was most intrigued by how PatientMatters offers unique payment plans to patients based on a wide variety of factors including current credit information, payment history for current financial obligations, and their residual income. From this information PatientMatters does an assessment of a patient’s ability to pay based on these five categories:

  1. Guarantors that generate this designation are the most likely to pay their full obligation. This population predictably pays their full balance more than 94% of the time. Recognizing these guarantors provides key savings to the hospital:
    • Because these guarantors are most likely to meet their obligation, conversations with the registration staff regarding payment are brief and concise.
    • Recognizing the high likelihood of guarantor payment performance, many hospitals elect to keep these accounts in-house and not refer to their early out vendors. This generates vendor savings for the hospital.
  1. These guarantors also have a high collections success rate, but they may need more time and slightly reduced payment plans to meet their obligation. Using data analytics to understand the guarantor allows the hospital to structure a custom payment plan with a high likelihood of performance.
  1. Guarantors in this category require a higher degree of attention from the registration team. This group struggles to meet their financial responsibilities. A hospital that spends the extra time working with the guarantor on a highly structured payment plan will see collection improvements with this population.
  1. These guarantors fall into two categories; a) a low likelihood of meeting their financial commitment or b) guarantor may meet hospital charity program, based on their FPL status. Scripting will help the registration assess the guarantor and identify the best solution.
  1. These guarantors will likely be unable to meet their hospital obligation. Many times these individuals will qualify for the hospital charity, Medicaid, County Indigent or other assistance programs.

It’s not hard to see how this more personalized approach to a patient’s financial experience makes a big difference when it comes to collections, patient satisfaction, etc. However, what I loved most about this approach was how simple it was to understand and process. It’s worth remembering that a hospital’s registration staff are generally one of the lowest paid, highest turnover positions in any hospital. So, simplicity is key.

I love seeing practical, innovative solutions like the one PatientMatters offers hospitals. They make a big difference on a hospital’s bottom line. However, they also create a much better experience for the patients who mostly want to get through the billing process and on to their care. How are you customizing the financial experience for your patients?

Many Providers Still Struggle With Basic Data Sharing

Posted on February 15, 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.

One might assume that by this point, virtually every provider with a shred of IT in place is doing some form of patient data exchange. After all, many studies tout the number of healthcare data send and receive transactions a given vendor network or HIE has seen, and it sure sounds like a lot. But if a new survey is any indication, such assumptions are wrong.

According a study by Black Book Research, which surveyed 3,391 current hospital EMR users, 41% of responding medical record administrators find it hard to exchange patient health records with other providers, especially if the physicians involved aren’t on their EMR platform. Worse, 25% said they still can’t use any patient information that comes in from outside sources.

The problem isn’t a lack of interest in data sharing. In fact, Black Book found that 81% of network physicians hoped that their key health system partners’ EMR would provide interoperability among the providers in the system. Moreover, the respondents say they’re looking forward to working on initiatives that depend on shared patient data, such as value-based payment, population health and precision medicine.

The problem, as we all know, is that most hospitals are at an impasse and can’t find ways to make interoperability happen. According to the survey, 70% of hospitals that responded weren’t using information outside of their EMR.  Respondents told Black Book that they aren’t connecting clinicians because external provider data won’t integrate with their EMR’s workflow.

Even if the data flows are connected, that may not be enough. Researchers found that 22% of surveyed medical record administrators felt that transferred patient information wasn’t presented in a useful format. Meanwhile, 21% of hospital-based physicians contended that shared data couldn’t be trusted as accurate when it was transmitted between different systems.

Meanwhile, the survey found, technology issues may be a key breaking point for independent physicians, many of whom fear that they can’t make it on their own anymore.  Black Book found that 63% of independent docs are now mulling a merger with a big healthcare delivery system to both boost their tech capabilities and improve their revenue cycle results. Once they have the funds from an acquisition, they’re cleaning house; the survey found that EMR replacement activities climbed 52% in 2017 for acquired physician practices.

Time for a comment here. I wish I agreed with medical practice leaders that being acquired by a major health system would solve all of their technical problems. But I don’t, really. While being acquired may give them an early leg up, allowing them to dump their arguably flawed EMR, I’d wager that they won’t have the attention of senior IT people for long.

My sense is that hospital and health system leaders are focused externally rather than internally. Most of the big threats and opportunities – like ACO integration – are coming at leaders from the outside.

True, if a practice is a valuable ally, but independent of the health system, CIOs and VPs may spend lots of time and money to link arms with them technically. But once they get in house, it’s more of a “get in line” situation from what I’ve seen.  Readers, what is your experience?

HIM Leadership

Posted on February 25, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

Healthcare leadership is not for the faint of heart; this is especially true in these rapidly changing times we are experiencing in healthcare. There are many different moving parts involved in not only providing medical care but in the important behind the scenes tasks that keep healthcare operations running smoothly. Health Information Management responsibilities are part of these important tasks as they cover many different, multi-layered tasks that are governed by strict laws and guidelines within hospitals, physician practices, and other healthcare roles.

Throughout the day, an HIM leader’s conversation can quickly shift between coding and revenue cycle to physician documentation and workflow to scanning records and analyzing reports to releasing information and HIPAA compliance and everything in between. We have to have a thorough understanding of all of these areas and how they overlap with other departments and providers. Of course, none of these responsibilities occur in a consistent or predictable manner on any given day.

By nature, I am a sorter and an organizer and I feel content when everything has a place. But when my daily responsibilities jump around chaotically, I start to squirm a little. Some days I can’t even begin to jot down a to-do list with prioritization because everything is urgent and important and everything is needed now. My point is not to complain about having too much to do but rather to successfully accept all of the responsibility and strategize around it. One of my favorite quotes reminds us:

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The key is to never try to do it all alone. It is not a good idea to try to do everything yourself just because it seems there is no time to train others. Having a great team to support your goals is absolutely critical. Hiring skilled HIM professionals and delegating important tasks to them will create an outlet for these professionals to use their skills and creativity to explore new ways to get the job done. The end result is typically a win-win for HIM professionals, HIM leaders, and organizational performance. Another great quote says:

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This is definitely the key to successfully accomplishing goals and objectives when they seem overwhelming and numerous. We must work smarter not harder; especially when teams are shorthanded.

I know this is probably nothing new to those in similar HIM leadership roles but it always helps to hear that you are not alone. There are probably never going to be perfect days where everything works smoothly and everything fits into its proper place. Tackle all of those tasks as best you can, delegate the responsibility, encourage teamwork, and share in the success.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Another Giant In Play: 3M Looking At “Strategic Alternatives” For HIS Unit

Posted on September 14, 2015 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.

Given the staggering number of EMR launches that took place in the wake of the Meaningful Use kickoff, mergers, sell-offs and business failures were quite predictable. Despite the feds’ doling out $30B in incentive dollars, even that wasn’t enough to keep hundreds of EMR entrants afloat.

It hasn’t been as clear what would happen to large vendors with HIT interests, given that they had enough capital to ride more than one wave of provider adoption. The field has just begun to shake out, with only a small handful of major transactions taking place. Recent plays by large tech players include Cerner’s $1.3B acquisition of Siemens Health Services, which included the Soarian EMR. There’s also ADP’s sale of EMR solution AdvancedMD to Marlin Equity Partners after previously acquiring e-MDs. Not to mention Greenway and Vitera Healthcare Solutions joining forces and Pri-Med acquiring Amazing Charts.

Another major move was announced this April at HIMSS 15, when GE Healthcare announced that it was phasing out its Centricity Enterprise product. According to news reports, the Enterprise product only generated 5% of the Healthcare division’s EMR revenue. I could keep going, but you get the point.

Now, 3M has joined the fray, announcing this week that it was “exploring strategic alternatives” for its HIS business, including spinning off or selling the unit.  (It’s also considering keeping its HIS business on board and investing in its future.)  The company, which has signed Goldman, Sachs & Co. as strategic advisor and investment banker, says that it will probably announce what direction it will head in by the end of the first quarter of next year.

On the surface, 3M Health Information Systems looks like a very solid business. The HIS unit, which is focused on computer-assisted coding, clinical documentation improvement, performance monitoring, quality outcomes reporting and terminology management, reportedly works with more than 5,000 hospitals, plus government and commercial payers. According to 3M, the HIS business generated trailing 12-month revenues of about $730M, and has sustained 10%+ compounded annual growth for 10 years.

That being said, it’s hard to say what the fallout from the ICD-10 switchover will be, and it’s not unreasonable for 3M to consider whether it wants to compete in the post-switchover world. After all, while the HIS unit seems to be quite healthy, it’s certainly faces stiff competition from several directions, including EMRs with integrated billing and coding technology. Also, the company may be saddled with outdated legacy infrastructure, which makes it hard to keep up in this new era of revenue cycle management.

By the end of the first quarter of 2016, 3M will have had a chance to see how its customers are faring post-ICD-10, and how its customers needs are shifting. 3M will also find out whether other HIS players with (presumably) newer technology in place are interested in doing a rollup with its business.

Truthfully, if 3M doesn’t think it can benefit from investing in the HIS unit, I’m not sure who else would benefit from doing so. In fact, I’d argue that 3M is undermining its chances at a deal by waffling over whether it plans to invest or divest; as I see it, this implies that the HIS unit will be on life support without a major cash infusion, which is not something I’d find attractive as an investor.  If nothing else I’d want to buy the unit at a firesale price! But I guess we’ll have to wait until March 2016 to see what happens.

Hospitals Put Off RCM Upgrades Due To #ICD10, #MU Focus

Posted on December 29, 2014 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.

If you look closely at the financial news coming out of the hospital business lately, you’ll hear the anguished screams of revenue cycle managers whose infrastructure just isn’t up to the task of coping with collections in today’s world. Though members of the RCM department — and outside pundits — have done their best to draw attention to this issue, signs suggest that getting better systems put in has been a surprisingly tough sell. This is true despite a fair amount of evidence from recent hospital financial disasters that focusing on an EMR at the expense of revenue cycle management can be quite destructive.

And a new study underscores the point. According to a recent Black Book survey of chief financial officers, revenue cycle upgrades at U.S. hospitals have taken a backseat to meeting the looming October 2015 ICD-10 deadline, as well as capturing Meaningful Use incentives. Meanwhile, progress on upgrades to revenue cycle management platforms has been agonizingly slow.

According to the Black Book survey, two thirds of hospitals contacted by researchers in 2012 said that they plan to replace their existing revenue cycle management platform with a comprehensive solution. But when contacted this year, two-thirds of those hospitals still hadn’t done the upgrade. (One is forced to wonder whether these hospitals were foolish enough to think the upgrade wasn’t important, or simply too overextended to stick with their plans.)

Sadly, despite the risks associated with ignoring the RCM upgrade issue, a lot of small hospitals seem determined to do so. Fifty-one percent of under 250 bed hospitals are planning to delay RCM system improvements until after the ICD-10 deadline passes in 2015, Black Book found.

The CFOs surveyed by Black Book feel they’re running out of time to make RCM upgrades. In fact, 83% of the CFOs from hospitals with less than 250 beds expect their RCM platforms to become obsolete within two years if not replaced or upgraded, as they’re rightfully convinced that most payers will move to value-based reimbursement. And 95% of those worried about obsolescence said that failing to upgrade or replace the platform might cost them their jobs, reports Healthcare Finance News.

Unfortunately for both the hospitals and the CFOs, firing the messenger won’t solve the problem. By the time laggard hospitals make their RCM upgrades, they’re going to have a hard time catching up with the industry.

If they wait that long, it seems unlikely that these hospitals will have time to choose, test and implement RCM platform upgrades, much less implement new systems, much before early 2017, and even that may be an aggressive prediction. They risk going into a downward spiral in which they can’t afford to buy the RCM platform they really need because, well, the current RCM platform stinks. Not only that, the ones that are still engaged in mega dollar EMR implementations may not be able to afford to support those either.

Admittedly, it’s not as though hospitals can blithely ignore ICD-10 or Meaningful Use. But letting the revenue cycle management infrastructure go for so long seems like a recipe for disaster.

Study Says Overcharging by the Hospital Might Be Overstated

Posted on August 1, 2014 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.

Despite concerns first raised a few years ago, hospitals do not seem to be abusing their electronic data systems to generate bigger bills and boost their income — at least according to authors of a large study released Tuesday. Other leaders in the field say the jury’s still out.

The concern over possible misuse of records grabbed headlines in 2012 after an investigation by the Center for Public Integrity and the New York Times found that some hospitals using electronic records were billing Medicare for significantly more than hospitals that still used paper records.

After the stories appeared, the Departments of Justice and Health and Human Services sent hospitals a strongly worded letter warning them against misusing the ease of electronic forms to pad their bills.

Source

What an interesting study. I especially like the part of the article where they suggest that hospitals aren’t charging more for their services because of EHR because the hospitals had already been maximizing their revenue for a long time before EHR. It’s a fine point that’s worthy of consideration. I don’t think it’s as true in some ambulatory practices, but in the hospital world they’d made a lot of efforts to maximize their revenue even without EHR.

One angle the article above doesn’t cover is that many people were suggesting that this EHR over billing of services was fraud on the part of these organizations. I’ve always thought that was ridiculous. Sure, fraud exists and is facilitated by technology in many cases. However, what the majority of hospitals are doing to maximize revenue isn’t anywhere close to fraud. The problem is that Medicare and other payers have been able to avoid paying for services that were rendered, but never billed. If EHR has increased claims (and this study suggests it hasn’t), then I’d submit it was because hospitals are finally charging for all of the services their rendering.

What do you think? Does EHR increase the cost of healthcare by charging for all of the services provided? Does EHR facilitate fraudulent claims?

4 Tips on How to Improve Your Patient Accounts Receivables (A/R)

Posted on May 12, 2014 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.

Many systems and provider groups think they are handling patient receivables management well, but the reality is that most of them have a very antiquated patient revenue cycle management strategy. In today’s medical landscape, a proactive approach is not just preferred, it is essential.

With ANI 2014 just around the corner, I’m sure I’ll be covering this a lot more. In the mean time I thought that readers might find a whitepaper with 4 tips to significantly increase patient payment revenue useful.

The whitepaper highlights something that I’ve seen as well. Most hospital leaders think that they’re handling their patient receivables management really well. The reality is usually very different than their perspective. Once they dig into the numbers, they realize really quickly that there’s a lot that they can do to improve it.

The great part is that the 4 tips aren’t rocket science. They are all easy to understand and implement. Sometimes all you need is to read a blog post and see a whitepaper with the tips to remind you to check it out.

Health Exchanges Pose Added Stress For Hospital IT Departments

Posted on September 30, 2013 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.

There’s no doubt that hospital IT departments have their hands full already, what with Meaningful Use and ICD-10 hovering over them like a huge black cloud. But as one Information Week story reminds us, there’s another big project in the wings which could add even more to their plate.

The IW story, which offers intelligence from the American Hospital Association and several consultants, notes that the coming of health exchanges and the accompanying Medicaid expansion in some states will have a substantial effect on hospital IT departments.

For one thing, the story reports, with a flood of newly insured Americans arriving at the door, hospitals will need to enhance their revenue cycle management systems, as the number of health plans with which they do business should rise meaningfully.

Hospitals will need to deal with the fact that some patients who buy insurance on the exchanges will have high deductibles and copayments, in some cases as high as $5,000 or $6,000. Given these deductibles, it will be crucial for hospitals to determine what kind of coverage patients have. Many hospitals will end up upgrading their RCM systems to better interface with managed care plans.

Unfortunately, even that won’t assure payment. As the IW story points out, even a direct connection to the insurance company in question may not do the job, as eligibility information from health plans is often 30 – 90 days out of date. “So if patients miss two premium payments and are no longer covered — but the data says they are covered, and the hospital proceeds accordingly — the bill never gets paid,” according to Thad Glavin, senior director of the Advisory Board’s RCM division, who spoke with the magazine.

Still, hospitals will need more and better connections with health plans even if the information they get in return is questionable. Sure, despite the risks that come with the change in insurance under the Affordable Care Act, I wager that hospitals’ steely focus on Meaningful Use and ICD–10 will leave RCM projects shortchanged at first. But as the high-deductible bills keep building up, hospitals will squeeze in new RCM system development. I give it six months to twelve months, max.

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.