4 expert tips for improving revenue cycle cash flow

Revenue cycle cash flow is more important than ever for hospitals as patients take a greater financial role in their care.

At the Becker's Hospital Review 9th Annual Meeting on April 12, the following panelists discussed how their organizations work to boost cash flow through clinical documentation and technology.

  • Gerard Brogan Jr., MD, executive director of Huntington (N.Y.) Hospital and medical director of revenue operations at New Hyde Park, N.Y.-based Northwell Health
  • Ryan O'Hara, chief revenue officer of Flagstaff-based Northern Arizona Healthcare
  • Michele Napier, chief revenue officer of Orlando (Fla.) Health
  • Dan Pope, senior vice president of revenue cycle management operations at Intermedix, a provider of RCM, practice management and data science and analytics solutions.

Here are four takeaways from the discussion.

Improving clinical documentation

1. Invest in documentation education. Mr. Pope believes RCM begins when the clinician or ancillary staff provides care. He said hospitals should invest in education and knowledge transfer with those workers so they know the importance of their duties and the information they're documenting. "Clinical documentation is crucial … you will never have the opportunity to collect a dollar that hasn't been documented," Mr. Pope said.

2. Engage physicians with quality in mind. Mr. Brogan recommended hospitals emphasize quality when engaging with physicians on clinical documentation improvement. He said this involves educating physicians on how quality data is used. "There's a little bit of wind at our backs if we explain to physicians how risk adjusting occurs and how they are tiered by insurance companies," he said. Mr. Brogan also noted hospitals should provide physicians with concrete ways to improve their documentation that are specific to their practice area.

3. Focus more on yield. Mr. O'Hara stressed focusing on yield instead of cash with respect to clinical documentation integrity. He gave the analogy in which net revenue is a dollar and cash is 98 cents. He said he's realized it's easier to move the former rather than the latter. "It's much easier to move net revenue and just let cash lag behind it," Mr. O'Hara said. "They're not binary. You still have to do both. But, I think sometimes we forget about moving the dollar and we're focusing on that two-cent gap. I think we get kind of deduction-focused sometimes."

Technology's role in lowering cost

4. Focus on the Cs. When selecting vendor partners regarding their technology, hospitals must consider various factors. Ms. Napier, whose organization outsourced coding, recommended hospitals specifically look at cash, contract, change and control. She said this involves hospitals asking themselves questions such as: "Are you trying to improve cash?" and "How much change are you expecting?" Hospitals may also ask, "Are you ready to invite third parties into the discussion?" Overall, she said focusing on these Cs helps organizations determine whether they are on the right path as far as outsourcing.


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