Cone Health's Mike Simms on revenue cycle collections: 'Be up front with the patient'

After 30 years in healthcare, Mike Simms still gets excited about his work.

"You must have a passion to be in the revenue cycle as long as I have," he said.

Mr. Simms, who has served as vice president of revenue cycle at Greensboro, N.C.-based Cone Health since 2013, said the job brings new challenges each day, and he enjoys being involved in the organization's financial processes.

"I still review patient accounts on a daily basis to give kudos to people who are doing a good job working those accounts," said Mr. Simms. "Also, maybe somebody missed a step in the process and we have a gap [in workflow] somewhere that I can assist in discovering. I also look at our patient portal and answer questions from our patients. This allows me to see the type of questions that patients are asking about their bill and determine if there are trends that are affecting patient satisfaction."

Becker's Hospital Review recently caught up with Mr. Simms to discuss his proudest moment as a revenue cycle leader, how he addresses revenue cycle challenges and the advice he would pass along to other revenue cycle leaders.

Editor's note: Responses were lightly edited for length and clarity.

Question: What is your proudest moment as a revenue cycle leader?

Mike Simms: The proudest moments have been the successful teams we've been able to work with. In every one of my career adventures, we've developed management and staff teams that have met metrics [goals]. I've been blessed to work with talented staff. My role is to mentor them and help guide them in their careers. That's my main responsibility — to guide them, to mold future leaders in the revenue cycle.

Q: What is the biggest revenue cycle challenge you face right now, and how do you address that?

MS: The biggest challenge we're going to face here in North Carolina is the change from traditional Medicaid to Medicaid Managed Care, effective Feb. 1. That's going to be challenging [because] there are four payers that will be servicing the Medicaid population. We're worried about how the implementation will go and how it will affect cash flow. What kind of denials are we going to face? Are we going to have more denials than we ever had since we have four managed care payers processing claims?   

Q: What is your take on the best approach to maximize reimbursement and meet patient financial experience expectations? 

MS: You've got to be up front with the patient, and you need to give them the [price] estimate from the very beginning. We all have our chargemasters posted now, but [President Donald Trump] wants us to be able to provide what our negotiated rates are, and I don't know if that's going to happen. But I think the key is to educate the patient at the beginning about what they will owe and attempt to collect it. If you can't collect at all, at least get a deposit, because the success of collecting from patients goes down significantly after they leave, and we spend a lot of effort on the back end trying to collect that.

The other aspect of collecting dollars from the patient is you have to have payment plans that patients can afford to pay. But you don't want to go back to the old days where hospitals would take $10-a-month payments on a $10,000 balance. We have an internal payment plan that allows for 12 months based off the account balance, and if the patient can't make the payments within 12 months and needs more time, then we have a loan program. We utilize a loan vendor where the patient will sign up with them. The patient will receive a zero-interest payment plan based on account balance and after the patient makes their first payment, we get the balance on the account, less a service fee. That helps us out greatly because we're getting the cash faster and not waiting months or years for account balances.  Yes, there is a possibility of recourse (patient stops paying) but our recourse rate has been around 7 percent, which is not significant.

Q: If you could offer a piece of advice or other revenue cycle leaders, what would it be?

MS: Empower your staff to make decisions. I trust my leaders and staff to make decisions and invite them to make decisions on technology that you are attempting to implement. It should not be just one person making the decisions, as there is no "I" in team! It's better to have a multitude of ideas and thoughts to have a successful team.


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