Biggest challenges facing revenue cycle leaders

As the midpoint of 2022 approaches, Becker's asked revenue cycle leaders about the biggest challenges they're facing.  

Here are what four leaders had to say: 

Note: Responses have been lightly edited for length and style. Responses are in alphabetical order by last name. 

James O'Connell. Director of revenue cycle at Inspira Health (Vineland, N.J.):

Currently, I believe the greatest challenge to most hospitals is maintaining staff in the revenue cycle. Filling open positions in both the front-end registration and back-end patient accounting areas has become very difficult. Inspira, like many hospitals, is running at only a fraction of the budgeted positions for these areas. 

We are also experiencing turnover after people hired into these positions have been in place long enough to transfer into other areas of the hospital. It is not unusual for the business office and registration to be the entry point into the system for someone seeking other opportunities. However, now with the shortage of qualified candidates out there, it is only exacerbating the situation when we train someone for three to six months, and then they immediately transfer out of the revenue cycle to a position that pays them 5 percent  to 10 percent more per hour. 

Richard Peer. System director of revenue cycle at Bristol Hospital and Health Care Group (Bristol, Conn.): 

Authorization determinations for the medically necessary care of Medicare Advantage patients continues to be delayed or denied, consistent with the OIG's latest report

For example: A hospital patient is ready for transfer to a skilled nursing facility on a Thursday or Friday, and by not working weekends, the carrier case management department delays the authorization determination until the following Monday. As the patient is unsafe to discharge home, and the skilled nursing facility requires authorization for their stay, the patient remains an inpatient at a higher level of care than necessary for the weekend, at a cost to the hospital without any additional reimbursement, and the Medicare Advantage plans profits by not having to pay for the nursing home per diem for the weekend.

Kerry Rogers, Vice president of revenue cycle at Beth Israel Deaconess Medical Center (Boston):

We are finding particular challenges in the following areas:

1. Pharmacy: Payers shifting site of care for services

2. Clinical definitions: Payers establishing their own qualifying criteria for complications/comorbidities (e.g. sepsis, malnutrition).

3. Data: Ability to produce/access actionable data to drive automation and focus manual work appropriately

Anne Rose, Vice president and chief revenue cycle executive at Lee Health (Fort Myers, Fla.):

One of the biggest challenges we face is navigating the complexities of third-party payer requirements and payment policies, both government and private, while offering our patients a financial experience that supports them through their personal healthcare journey. Assisting our patients is always our focal point.

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