Hard Truths from the Revenue Cycle Management Pros

Becker’s Hospital Review is a respected forum for healthcare industry thought leaders and has long offered valuable insights into the latest healthcare trends. In these disruptive times, amidst sweeping changes, generalities are scarce and predicting the future is riskier than ever. Here are the unalloyed truths and toughest advice from industry experts who have been interviewed in their publications this past year:

The Bar is Higher for Hiring Back-Office Personnel.

Bruce Haupt, CEO of ClearBalance, said:

“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.”

Are You Putting Your Captured Data to Best Use, to Grow and Protect Your Business?

Brad Arthur, director of the business office of St. Elizabeth Healthcare (Edgewood, Ky.) said:

“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 run business office.”

Leadership and Culture is Critical to Strategic Success.

Also from Brad, the following applies to organizations in any rapidly evolving business environment:

“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 … At St. Elizabeth Healthcare we have created a culture where ideas are supported by data and analytics but most importantly by effective leaders.”

The Consumer is Concerned about Cost and Convenience. Are You?

Jon Neikirk, assistant vice president of revenue cycle of Froedtert & the Medical College of Wisconsin (Milwaukee) notes:

“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.”

Get All Teams On Board and Rowing in the Same Direction.

Laura Holt, director of revenue cycle management of St. Luke’s Hospital (Chesterfield, Mo.) said:

“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.”

Denied Claims Are Disruptive Cost Multipliers.

Jim Lazarus, managing director of strategy and innovation with Advisory Board’s revenue cycle solutions division, warns:

“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.”

Is Your Revenue Management Process Sustaining or Draining Your Practice?

Ralph Catalano, senior vice president of operations of RCM vendor CareCloud, agrees:

“It’s all about looking at [the billing cycle] as a workflow. The [practice] that uses an inefficient system, or reviews documents whenever they get around to it—they 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.”

Remember, a best-of-breed medical billing partner can help. Watch this space for more news and opinions on the latest industry developments impacting your organization.


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