46 RCM tips from 2018

Here are 46 expert revenue cycle management tips, published by Becker's Hospital Review in 2018.

1. Tom Romeo, general manager of healthcare IT and Quanum Solutions at Quest Diagnostics, recommended hiring the right staff and utilizing their strengths appropriately.

2. Erica Franko, senior vice president and managing director of advisory and implementation services at RCM company nThrive, recommended that hospitals address patient liability by focusing on the patient experience and staff.

3. Rebecca Farrington, chief revenue officer at Healthcare Administrative Partners, recommended properly educating patients about separate billing at the time of service.  

4. Peter Angerhofer, principal at Colburn Hill Group, recommended using advanced technology to target smaller subsets of claims.

5. Deborah VanCleave, vice president of revenue cycle at St. Joseph, Mo.-based Mosaic Life Care, recommended hospitals focus on the patient's perspective.

6. Ms. VanCleavealso recommended that hospitals view the revenue cycle as a brand ambassador.

7. Dan Berger, national director of healthcare at AxiaMed, a healthcare financial technology company, advised hospitals to take steps to ensure compliance with HIPAA and payment card industry requirements with regard to patient payment collections.  

8. Gerilynn Sevenikar, vice president of revenue cycle at San Diego-based Sharp Healthcare, said hospitals need to make sure they give their patients personal, customized service.

9. Parag Shah, president of practice solutions at Integra Connect, a provider of technologies and services for value-based specialty care, advised specialty medical practices to focus on performance optimization and risk management to ensure their revenue cycles meet new value-based care requirements.

10. Elaine Dunn, vice president of system integration for Craneware, a value cycle company, said it is critical that hospitals and health systems examine how the organization's clinical systems integrate with the chargemaster.

11. Jenna Tropea, online marketing strategist at ImagineSoftware, a provider of billing automation software and revenue management applications, recommended hospitals track claim denial resolve rate to improve revenue cycle performance.

12. Rebecca Marsh, vice president of advisory services at nThrive, a revenue cycle management company, advised hospitals to conduct a comprehensive review of their chargemaster to prepare for the CMS price transparency rule taking effect Jan. 1.

13. Mark Mele, vice president of sales at Casetabs, a cloud-based surgery coordination technology provider, said hospitals should remember the importance of reducing operating room delays and last-minute cancellations as they seek to improve financially.

14. Kevin Smith, vice president of product management at nThrive, recommended hospitals use online estimator tools to help patients understand their potential out-of-pocket costs.

15. Gary Long, executive vice president and chief commercial officer of R1 RCM, a provider of technology-enabled healthcare revenue cycle management services, advisedhospitals to include both clinical interactions and nonclinical interactions when considering net promoter scores.

16. Allen Latham, vice president of revenue cycle management at TriZetto Provider Solutions, a Cognizant Company, said hospitals should focus their revenue cycles on healthcare consumers as well as healthcare "prosumers," who gather their own health data via a wearable or sensor.

17. Dr. Dar Griffeth, senior vice president of revenue cycle management services at Pulse Systems, said lowering the number of days a bill is in accounts receivable is one way to reduce the cost to collect on the bill.

18. Bo Shi, assistant professor of finance at Morehead (Ky.) State University, said data analytics — using technology to examine and make conclusions from data sets — can help hospitals and health systems improve revenue cycle performance.

19. Scott Friesen, CEO of Newport Credentialing Solutions, an outsourced provider for privileging and credentialing solutions, said credentialing software — which helps manage the process of establishing a provider's qualifications, board certifications, work history and references — should be integrated with provider-payer contract data.

20. Lyman Sornberger, president and CEO of consulting firm Lyman Health Care Solutions, said that hospitals should "capture insurance coverage at the benefit level" and "invest in pre-service validation with the patient and insurance for high-end service."

21. Jay Garmon, product manager of patient responsibility at Waystar, said hospitals should establish programs to help patients pay their medical expenses. He gave the example of consistently offering cost estimates to patients before procedures, so they can financially plan for their out-of-pocket costs and seek financial assistance if needed.

22. Jonathan Wiik, author of Healthcare Revolution: The Patient is the New Payerand principal for healthcare strategy at TransUnion Healthcare, said hospitals should use technology to evaluate propensity to pay.

23. Paul Shorrosh, founder and CEO of AccuReg Software, said standardizing and automating front-end processes, such as registration, helps eliminate revenue cycle errors.

24. Paul Brient, CEO of PatientKeeper, said it's important that healthcare executives cultivate an atmosphere that fosters collaboration with physicians toward hospital goals.

25. David Shelton, CEO of PatientMatters, said hospitals should consider a patient's traits when establishing a payment plan. Establishing payment plans that include current credit information, payment history for financial obligations, residual income and other unique patient statistics should all be considered in the billing process, he said.

26. Erica Franko, senior vice president and managing director of advisory and implementation services at nThrive, recommended hospitals address patient liability by focusing on the patient experience and staff. "Many patients remember the days of the co-pay and are now confronted with more complex forms of liabilities. Ensuring that your staff is prepared to explain these liabilities is paramount to patient and staff satisfaction," Ms. Franko told Becker's. "Be sure to also prioritize point-of-service collections. Patients are more likely to pay upfront, especially if they understand how much and why they owe, and they are provided support options, if needed."

27. Jim Dougherty, CEO of Madaket Health, recommended cutting out manual, error-prone processes in payer-provider transactions. He said healthcare organizations should automate enrollments necessary for payments.

28. Lyman Sornberger, vice president of client development at Charles J. Hilton and Associates law firm, provided three operational processes in revenue cycle management to respond to insurance claim denials. These processes include informal and formal appeals. He said providers also may bring in a third-party healthcare attorney to respond to denials.

29. Kevin Smith, vice president of product management at nThrive, said hospitals should use technology to examine changes before bills are sent to patients and identify areas of potential charge discrepancies.

30. Heather Bassett, MD, CMO of Xsolis, recommended using objective analytics to work with payers during case management.

31. Tyler Kurasek, a principal at Colburn Hill Group, an end-to-end revenue cycle solutions firm, recommended looking to analytics when using robotic process automation to improve RCM. "Using analytics to find patterns of claims that may not have the same characteristics, but require the same next step, is one way to build a volume of tasks that justifies using a robot," he said. "Once the patterns are identified, and the robot is built, managers need to monitor its use and activity to ensure not only that all claims which qualify are being processed, but also that any new populations which should qualify are included."

32. Tom Romeo, general manager of healthcare IT and Quanum Solutions at Quest Diagnostics, said hospitals and health systems must identify the cause of insurance claim denials to ensure proper and timely payment.

33. Tara Dwyer, vice president of audit operations at Xsolis, recommendedhospitals prioritize claim denial appeals based on the clinical merit of individual cases.

34. Monte Sandler, executive vice president of revenue cycle management at DocuTAP, recommended healthcare providers follow appropriate billing guidelines for each contract with third-party payers.

35. Rebecca Haymaker, director of Epic services at Parallon Technology Solutions, recommendedhospitals educate patients and staff to achieve a successful point-of-service collections program.

36. Jason Considine, senior vice president of patient access, collections and engagement for Experian Health, recommended hospitals closely examine online reviews from patients to gain insights to improve customer satisfaction and boost payments.

37. Amber Luliano, product manager of denial management at Waystar, recommended that hospitals invest in an effective denials program to prevent denials and ensure they recoup maximum revenue for services.

38. Eric Nilsson, chief technology officer of the SSI Group, a revenue cycle solutions company, recommended that hospitals improve cybersecurity by implementing an established security framework that meets organizational needs without being overbearing.

39. Deepti Sharma, director of product management at HSBlox, said blockchain and advanced artificial intelligence algorithms provide the answer for healthcare organizations seeking to reduce claims denials and ensure maximum provider reimbursement.

40. Rebecca Farrington, chief revenue officer at Healthcare Administrative Partners, recommended that hospitals gain insight by collaborating with hospital-based physicians.

41. Andrew Trechsel, senior associate at  executive search firm Witt/Kieffer's healthcare practice, said career stability and ambition should be a key focus for revenue cycle consultants.

42. Ryan O'Hara, chief revenue officer of Flagstaff-based Northern Arizona Healthcare, recommended focusing more on yield with respect to clinical documentation integrity.

43. Kenneth Miller, senior revenue cycle management specialist at Cantata Health, recommended using a hospital's RCM team to gain various insights that can result in improved performance.

44. Eric Ritchie, COO of Grantsville, W.Va.-based Minnie Hamilton Health System, recommended using one platform to keep track of revenue cycle management processes.

45. Kevin Lathrop, president of TriZetto Provider Solutions, a Cognizant company, said hospitals and health systems should focus on price transparency as they pursue the retail-like financial experience patients seek in today's healthcare environment.

46. Leonard Wenyon, vice president of revenue cycle management solutions at IKS Health, said focusing on insurance verification can help providers improve patient payments.


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