September 09, 2016

Written by Kelly Gooch

OR Efficiencies

Amid these and other changes, many revenue cycle professionals have offered thought-provoking insights this past year.

Here are six thoughts from industry leaders on the nature of revenue cycle management in 2016, garnered from past Becker’s Hospital Review articles.

1. “As patients take on more financial responsibility for their medical care, the professional criteria for successful registration and billing department employees has changed. Revenue cycle leaders need to consider new applicants with a high level of financial and insurance expertise who are capable of engaging patients in productive conversations about their benefits. Hospitals have a vested strategic interest in developing and recruiting RCM personnel with a higher skill set, and that requires capital investment.” — Bruce Haupt, CEO of patient financing company ClearBalance 

2. “You have to have access to good data and analytics. Build your key performance indicators that align, support and cascade with all areas of the revenue cycle including access, pre-access, clinical documentation improvement, health information management and the business office. Review data that supports your key performance indicators every single day of the year. There should never be surprises to your financial leaders in an effectively ran business office.

Also, hire the right people and create a culture that aligns with your organization’s strategic plans and goals. It’s not always about financial metrics, it can be about culture. For example, net revenue is important to most financial leaders but do you review your cost to collect to determine the overall effectiveness of your revenue cycle?  Is it more effective and efficient to insource a particular part of the revenue cycle and does the culture support that? Will your leaders support adding full-time equivalents that in the end will drive down outsourcing costs? At St. Elizabeth Healthcare we have created a culture where ideas are supported by data and analytics but most importantly by effective leaders.” —Brad Arthur, director of the business office of St. Elizabeth Healthcare (Edgewood, Ky.)

3. “Focus on the patient experience, and make it the driving force behind projects you take on. Price transparency is our biggest one lately. The healthcare industry needs to move this topic to the front of conversations with patients. Let them know what to expect in a way that’s meaningful to them. We recently started giving patients out-of-pocket cost estimates. I also would recommend keeping an eye on self-service technology — apps that let patients self-schedule and do other things. It’s the way things are going in the future.” — Jon Neikirk, assistant vice president of revenue cycle of Froedtert & the Medical College of Wisconsin (Milwaukee)

4. “Healthcare providers should examine the entire lifecycle and not overlook the simple steps at the beginning. Recently, St. Luke’s smart use of technology has propelled performance forward. We carefully select appropriate forms of technology to support our revenue cycle and make sure we use it to its fullest potential.

At the core is having an engaged, productive staff and forming great relationships with other departments in the hospital. Cross collaboration is vital, and providers should create a culture of teamwork among all areas. Focusing on the patient experience and helping patients understand how to access the healthcare services they need and how to manage healthcare costs also positively impacts the revenue cycle.

Each of these pieces is great individually, but the trick is getting them all to work together. That’s when you get outstanding performance in your revenue cycle management.” — Laura Holt, director of revenue cycle management of St. Luke’s Hospital (Chesterfield, Mo.)

5. “Organizations are struggling because they have so many [claim] denials that require devoted efforts. Beyond just the financial impact of denials, the rework [of denied claims] prevents organizations from being able to be more successful in their revenue cycle and even in their work with patients because they have to keep addressing this issue.” — Jim Lazarus, managing director of strategy and innovation with Advisory Board’s revenue cycle solutions division

6. “It’s all about looking at it [the billing cycle] as a workflow. The doctor that uses an inefficient system or documents whenever they get around to it, may think it’s just a drain on them and their time, but it actually delays billing in many cases or causes inaccurate billing. I think what threatens the existence of small [medical] practices in particular is not whether they have enough patients but rather cash flow problems. And a lot of times those cash flow problems come from a poor workflow.” — Ralph Catalano, senior vice president of operations of RCM vendor CareCloud

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