Clinical-Financial Alignment Simplifies Revenue Cycle for Patients

According to Jeff Hurst, the senior vice president of finance at Florida Hospital, the revenue cycle trend hospitals should be moving towards is the integration of financial and clinical operations, in an effort to create a more consumer-friendly revenue cycle.

 

“Historically, the healthcare industry has done a good job advocating for patients in a clinical setting, and helping the patient understand what to expect during treatment. But the financial side of the healthcare industry has not kept pace with the clinical side,” Hurst, who directs all financial and clinical revenue cycle functions at Florida Hospital, told Healthcare Finance. “Our job from a revenue cycle standpoint is to help the patient navigate the financial intricacies of the healthcare system.”

For Hurst, this means simplifying the healthcare finance system for the patients through proactive “education and outreach” in order to increase patient understanding. Florida Hospital, a 2,247-bed, multi-site acute-care organization, has launched several initiatives in recent years to achieve this simplification. One major innovation includes increasing transparency surrounding out-of-pocket costs through price-estimate phone lines and online applications which allow patients to get estimates on their out-of-pocket responsibility based on their unique circumstances.

“Revenue cycle must learn to focus on continuous improvement of the patient experience,” said Hurst. “The patient experience has to extend beyond the clinical to the finance side of the business.”

As Nearterm sees it, this strategy is underway in most health systems. However, the strategy still  has a long way to go in order for most to operationalize it. This is mostly due to the prioritization of spending in light of the cost of re-design and implementation.

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Creating a Hospital Quality Management Cycle

According to Susan DeVore, president and CEO of Premier, Inc., a healthcare improvement company, today’s healthcare providers are being judged on more than the amount of payment for a procedure and the effectiveness of their billing and collection process. They’re also being increasingly evaluated based on their quality, creating a need for “total quality management.”

In a new op-ed published in the Wall Street Journal, Devore notes that, in today’s health-care industry, “the quality of care is just as important to a hospital’s revenue as making sure claims are paid properly.” Additionally, federal programs requiring hospitals to publicly report their outcomes, as well as rewards or penalties as a result of these outcomes, put pressure on hospitals to perform well. As a result, understanding how to measure performance is essential to a hospital’s success. 

“Much like the revenue cycle process, hospitals need to be able to keep track of and manage the quality cycle of care to determine the most important areas of focus and consistently meet high-performance measures,” she writes. “If we take some of the best practices from the revenue cycle, we can implement a quality cycle management process that aligns and focuses firmly on the specific elements of performance that produce continuous quality improvement, and in turn, a healthier balance sheet.”

In the article, Devore notes that these “best practices” include “a clear cadence, metrics with targets, a firm culture of accountability and… deep executive engagement to generate change.”

“Yesterday’s revenue cycle management is today’s quality cycle management,” she says.

Nearterm sees RCM quality metrics as a subset of the overall mission that hospitals embrace which is to deliver quality care in a sustainable way. Quality cycle, in our opinion, is as much among the objectives of RCM as it is also among the objectives of Nursing Services, Supply, and other operational areas of care.

AMA President Urges Physicians to Prepare Billing Cycles for ICD-10 Implementation

In response to a letter to the Centers for Medicare & Medicaid Services (CMS), which expressed concern regarding the potential for an accumulation of millions of dollars in unpaid Medicare claims following the ICD-10 implementation, American Medical Association (AMA) President Robert M. Wah is urging physicians to prepare their billing cycles for the transition.

The letter, which was a joint effort from a hundred physician groups, including the AMA, expressed concern that contingency plans have not been established to prevent critical billing disruptions caused by the implementation of ICD-10, which goes in to effect October 1.

“By CMS’ own analysis, one of the most significant risks to moving to ICD-10 is the likelihood for claims processing and cash flow interruptions,” the letter states.

AMA President Wah told RevCycleIntelligence.com that the biggest concern regarding the transition to ICD-10 was demonstrated in CMS’s end-to-end testing, which found a decline in claims acceptance, from 97 percent to 81 percent, among the relatively small sample size tested.

“When this is expanded to all physicians and all claims, the results may be disastrous,” Wah said.

Wah also pointed to issues with previous HIPPA implementations, including NPI and Version 5010, which left some physicians unable to be paid by Medicare for several months.

“Some practices were at the point of being unable to make payroll for staff and needing to temporarily close the practice, or obtain lines of credit with financial institutions until processing was complete,” Wah states. “We are extremely concerned that physicians will face similar issues as a result of the switchover to ICD-10.”

To prepare for the transition, Wah is urging physicians to prepare for the federal mandate.

“Physicians will need to closely track various metrics for their claims including pending claims, rejected claims, days in accounts receivable and payments,” says Wah. “Any issues will need to be addressed and reworked as early as possible to prevent a backlog of unprocessed claims and lack of reimbursement.”

Nearterm can help you get your RCM in top shape in preparation for the ICD-10 compliance date of October 1. We offer coders, claims specialists, and billers to work onsite or remotely. 

Read the entire article on RevCycleIntelligence.com

How Outsourcing RCM Supports Company Growth: A Client’s Perspective

Several years ago, Capital Women’s Care (CWC), an obstetrics and gynecology group in the Maryland, Virginia and Washington, D.C. areas, was facing a challenge with regards to their revenue cycle. According to Debbie Redd, CWC’s President and CEO, the practice’s revenue cycle was “not functioning to its full potential,” hindering the company's ability to grow.

In a recently-published article from Healthcare Finance News, Redd details how the practice overhauled their revenue cycle management system by streamlining the internal front-end financial processes and outsourcing back-end billing efforts.

According to Redd, the choice to outsource was a “practical alternative to keeping things in-house,” as it allowed the practice to “rely on an expert whose sole business is revenue cycle management” while freeing up time for the practice to “focus on expanding… and supporting providers in high-quality clinical care for patients.”

Overall, Redd concludes that outsourcing back-end processes both stabilized CWC’s financial operations and built a foundation of support for the company’s expansion. 

"Before we began outsourcing our backend processes, our days in A/R were over 100," writes Redd. "Now we consistently see rates of less than 20. We also have about a 99 percent collection rate."

Additionally, Redd notes that the strong changes made to the front- and back-end of the revenue cycle make the organization “more attractive to new providers and potential partners.”

“Providers come to us seeking membership because they see how we effectively manage both the clinical and business sides of the practice. This has allowed us to expand our business and prepare for the coming changes in healthcare.”

Read the entire article on Healthcare Finance News.

Nearterm provides healthcare revenue cycle management (RCM) services for hospitals, medical clinics, and physician practices. Our RCM services are designed to provide clients with practical solutions and assist them toward strengthened financial positions.

The Damaging Effect Overstretched Revenue Cycle Management Resources have on Your Bottom Line

A recent Revenue Cycle Management (RCM) survey by NexGen Healthcare demonstrates the ways overstretched RCM resources can affect your bottom line.

According to the survey, which was conducted among practices across the nation and evaluated several high-level metrics, many medical practices are “falling short” of the best practices benchmark.

The survey found that the majority of practices, 77 percent, have between one and 10 people working in their billing offices. Only 7 percent said they had 25 or more employees working in a billing function. Additionally, only 15 percent of practices rated their ability to follow-up and resolve denials as 10 or “excellent”; 31 percent rated their abilities between 1-5.

According to Benjamin Colton and David Wofford of ECG Management Consultants, ineptitude and lack of technical knowledge may be contributed to the lack of qualified professionals within the RCM field.

“Unfortunately, revenue cycle management is often a thankless role with an unclear career path and therefore does not always attract top talent,” Colton & Wofford wrote in their article 6 Essential Elements for Physician Revenue Cycle Management. “Consequently, as physician practices are rapidly consolidated under hospital or health system ownership, the demand for people with the requisite skills is almost certain to exceed the supply and it will be common to find revenue cycle managers (and even directors) who struggle to see the way forward for their operation.”

According to the authors, the solution to this failure in RCM, which ultimately affects a hospital’s bottom line, is to outsource billing functions through a “sound, performance-driven contract that holds the vendor accountable.”

“Healthcare organizations that outsource portions of their revenue cycle operations typically do so to access advanced practice management capabilities more quickly or more economically than they could if they developed the operations on their own,” they write.

Nearterm provides interim management, executive search and project staffing for medical and healthcare organizations and hospitals nationwide. Our experienced and knowledgeable principal partners are actively involved in every RCM project we take on. Also, we are employee-owned and utilize an Employee Stock Ownership Plan (ESOP), giving each of our contractors the motivation to perform in an accountable manner. 

Nearterm has been recognized by TAPC and HAAPC for outstanding contract/temporary service in the Technical/Professional category. 

Health Information Management (HIM) to Surpass EHR Purchasing Amid Healthcare Reforms

According to a recently-released Frost and Sullivan report, health information management (HIM) and revenue cycle analytics are projected to surpass the electronic health records (EHR) purchasing market within the next few years, as hospitals adapt to meet the changes spurred by healthcare reform and the possible implementation of ICD-10.

"Hospitals understand they must establish new business models in order to survive under a dramatically transformed provider landscape," said Frost & Sullivan Connected Health Principal Analyst Nancy Fabozzi.

Read the entire article on Health IT Analytics.

Nearterm provides expert revenue cycle, financial management and health information management consulting for medical and healthcare organizations and hospitals. Contact us today to  learn how Nearterm can help your business.

Revenue Cycle Industry to See Changes in 2015

The New Year will be a year of changes for professionals in hospital revenue cycle, notes a new article from Healthcare Finance News. The biggest changes impacting the industry include the move from fee-for-service to population-based payment systems, as well as the possible implementation of ICD-10.

According to the article, it will become critical for those at the department level of hospitals to understand foundational revenue cycle management, a task which will be left up to revenue cycle management directors. Additionally, the article notes that uncertainty regarding whether or not congress will implement ICD-10 in October 2015 will have a large impact on hospitals, primarily because of the revision's effect on coding procedures.

“[IDC-10] will be a bigger change on the hospital side because they now have to code based on procedure codes instead of revenue codes,” Laurie DeSantis, vice-president of operations for HCL, explained to the website. “The unknowns are especially large because the payers haven’t released their payment policies yet. It is hard to say that even when the coding is correct how the payers will react.”

Over the years, Nearterm has developed a strategy that provides coding expertise anywhere in the United States to deal with existing requirements, as well as the requirements imposed by the implementation of ICD-10.

Read the entire article on Healthcare Finance News.