The New Year is an ideal time to take stock of organizational performance, look back at the previous year to identify successes and improvement opportunities, and at the same time, plan how to fully embrace the future.
With all the current uncertainty regarding healthcare reimbursement, especially as value-based care models continue to evolve, this year is a prime opportunity to review and assess an organization's revenue cycle operations. To that end, here are three strategies for organizations to keep in mind this year as they take a deep dive into their revenue cycle functions.
Create and enhance revenue capture opportunities
As time progresses, healthcare organizations will find it increasingly difficult to collect shrinking payer reimbursements and growing patient payments. However, with the right technology and workflows, an organization can holistically understand, manage and even integrate both aspects of the revenue cycle to ensure a continuously flowing revenue stream.
In regards to optimizing reimbursements from payers, there are several key steps an organization should take. First, organizations should consider measuring and reporting quality metrics to not only gauge performance but also capture quality-associated payments and reduce the potential negative adjustments on reimbursement amounts. Moreover, organizations that are or soon will be clinically and administratively interoperable with sufficient patient population size and the ability to implement team-based-medicine should think about participating in Advanced Payment Models (APMs). Quality and APM dollars are replacing fee-for-service dollars at an ever-increasing pace, and seizing these opportunities could be financially advantageous.
Another area where organizations can optimize payer reimbursement is through ensuring claims are clean upon first submission to the payer--regardless of whether a claim relates to fee-for-service or quality-based payment. The faster an accurate claim makes it to the payer, the faster cash will flow, allowing organizations to promptly receive full payment. For those claims that are rejected or denied, organizations should have solid processes and partners that assist in identifying and addressing issues, so claims can be re-submitted quickly and accurately. These same processes and partners can also work together to ensure that the right amount is reimbursed.
Organizations should also ramp up their focus on patient-generated revenue. Although collecting patient payment at time of service has always been a best practice, the emphasis on this activity is growing due to the increasing amounts patients are responsible for—which also represent an ever-larger percentage of an organization's total revenue. As such, healthcare providers must ensure front-office staff is equipped with the tools and information to fully collect what is due from patients either at the time of service or as an ensured and automated payment once payer adjudication is complete. Patient-focused technology can streamline pre-visit eligibility verification, benefit review and cost estimation, as well as offer timely and convenient payment options, including a credit-card-on-file solution that automates payment and facilitates payment plans.
Leverage data analytics
Nearly all healthcare care delivery and financial models require robust data capture, reporting and analysis. Consequently, healthcare organizations should be creating and implementing a data analytics strategy that reliably leverages clinical and financial data to uncover trends, opportunities and risks. Unfortunately, many healthcare entities are not currently employing this type of strategy, especially regarding the revenue cycle. In a 2016 survey commissioned by Porter Research and Navicure, more than half of respondents (55%) indicated they are not using a data analytics solution to assess and respond to revenue cycle performance. More than one-third of these respondents don't feel they need such solutions, and nearly 50 percent don't have the time or resources to use them. That said, the value of strong business intelligence is very real. It allows organizations to create a picture of their current state and pinpoint areas that are underperforming. This way they can target improvement strategies, allocating technology and resources to areas that need them most.
In addition to drilling down into data, an analytics program has to communicate information in an approachable and understandable manner. Tools such as dashboards can reveal at-a-glance performance while robust reporting capabilities let an organization dig into the roots of a problem. A data analytics program should also include benchmarking capabilities so that organizations can easily see how their performance changes over time and against peers.
Keep the patient at the center
As healthcare continues evolving, government and commercial health plans, employers and patients will increasingly demand "proof" from providers that they are delivering the best possible care experience. Although the semantics of what this means may change, the fundamental principles remain the same—ensure patients receive the right treatments at the right times, at the right prices and in the right ways. This may seem like a simple concept; however, to realize this goal, organizations must empathically, operationally and financially place the patient at the center of both revenue cycle and clinical operations.
Overall, the New Year presents tremendous opportunities to align payer and patient revenue streams and respond to the demands of various stakeholders. Organizations that seize the moment and rethink their processes, partners and care delivery models, aligning these components to provide patient-centered value, can set themselves up to support greater business success long term.
About the Author
Ken Bradley is vice president of strategic planning and compliance of Navicure, a provider of cloud-based healthcare claims management, patient payment and data analytic solutions. Follow Ken Bradley on Twitter at @Ken_Bradley.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.