5 takeaways on revenue cycle, payer contracting and data analytics

The revenue cycle has a key role to play in ensuring healthcare providers receive full reimbursement for the care they provide. Within the revenue cycle, data analytics can help identify problem areas for staff to address and improve upon.

In a panel at the Becker's Hospital Review 2nd Annual CIO/HIT + Revenue Cycle Conference, panelists from three organizations shared their thoughts on revenue cycle management, payer contracting and data analytics.

Panelists were Michael Berger, director of revenue cycle at New Brunswick, N.J.-based Saint Peter's University Hospital and president of The M. Berger Consulting Group; Amanda Crowell, director of payer contracting at West Des Moines, Iowa-based UnityPoint Health; and Jho Outlaw, senior vice president of revenue cycle services at SourceMed, a provider of software, analytics and revenue cycle management services for outpatient facilities.

Highlighted below are some of the main takeaways from the panel discussion.

1. Staff are still essential. Mr. Berger said quality revenue cycle staff is still needed today, even with data analytics and other technology that is available. However, organizations are not always able to attract experienced revenue cycle staff due to salary or budget constraints. Additionally, organizations are battling with the belief that technology can replace staff or, at minimum, significantly reduce staffing requirements. He said technology should continue to be viewed as an "enabler" — allowing organizations to do things they cannot otherwise do, do things better and potentially provide cost relief alongside a strong human workforce.  

2. Payer contracts should be understood by all staff. Data analytics inform staff when to follow up with payers on claims, but, to ensure full reimbursement by the payer, a provider's revenue cycle staff must fully understand the organization's payer contracts, Ms. Outlaw said. So her organization ensures contract transparency all the way down to the collector level. "I remember when we wouldn't let them see the contracts, but now we have learning sessions so they are familiar with the contracts and can have intelligent conversations with payers. Collectors have to have a certain [tenacious] personality type today," she added.

3. Set goals for staff. Ms. Outlaw's organization also sets collections goals for revenue cycle staff. Those goals don't only pertain to the number of payer accounts they must follow up with per day, but also outcomes. This means Ms. Outlaw holds her teams accountable to deliver tangible results for customers in key areas — for example, driving down days in accounts receivable (Less than 17 percent of accounts receivable above 90 days is considered healthy, per industry standards). Ms. Outlaw said monitoring these key performance indicators on a consistent basis using analytics helps ensure things are on track and spotlights potential problem areas to address before they become major issues.

4. Use metrics to measure revenue cycle progress. UnityPoint Health uses a metric called "net revenue yield" that compares the expected revenue from a claim (based on the contract built in the organization's financial system) to overall payments six months post-billing. For instance, UnityPoint Health found one payer had an 80 to 85 percent net revenue yield. That's not optimum, as the system's best payers are typically within 95 to 98 percent. "During negotiations, we inform payers of their net revenue yield. The payer then wants more analytics and denial reports," Ms. Crowell said.

5. Centralizing revenue cycle functions can help optimize data analytics. Ms. Crowell's organization has centralized more of its revenue cycle functions and oversight, which she said has been helpful in leveraging data analytics to get the most reimbursement from payers. Through a denials team, centralized coding and strong working relationships between the other revenue cycle roles that remain regional, data is more consistently tracked.  Previously, each region would send multiple emails to a contracting manager to keep track of trends and issues to share with a payer. With this new model, UnityPoint Health has consolidated reports to share trends data with payers.

 

More articles on finance and revenue cycle management:

Regional Medical Center's finances improve amid turnaround plan
5 characteristics of a successful value-based model
How is Indiana Medicaid faring?

 

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