Leaders from U.S. hospitals and health systems must navigate today's challenging reimbursement climate and changing expectations related to the patient financial experience.
Here, four leaders share their advice for the journey with Becker's Hospital Review:
Mary Beth Remorenko, vice president of revenue cycle operations at Boston-based Partners HealthCare: "Prioritization is something I would always recommend. [This means] making sure you're spending time on the things that are the most important — and that will yield the biggest value for your organization and patients."
Myriam L. Torres, vice president of revenue cycle at Miami-based Jackson Health System: "You need to dig into your data to understand your current status. To set an action plan for the future, you need to understand exactly where you are and know where you want to go. I think sometimes people make decisions because they go by a hunch, but they cannot validate it with numbers. We don't put any processes in place unless we have validated that, in fact, there is a need for improvement. We use an internal database, RC-AIM, to assist us with analysis."
Ron Wachsman, vice president and chief revenue cycle officer of Memphis, Tenn.-based Baptist Memorial Health Care: "Try to engage with other leaders in the organization, especially from the clinical operations area, to educate that leadership group on the importance of clinical documentation to ensure that the payment for that service is at the right amount. This involves documentation of services to make sure we can bill out the most appropriate diagnosis-related group. It involves making sure we have the right level of care. Sometimes insurance companies want to pay us as observation status when we can defend it as inpatient and get paid at the more appropriate, higher rate. There are also other things that affect how we code our claims. So, I think the more involvement with the clinical areas where they may not realize the impact they have on the final bill that goes out [is important]."
Brian Unell, vice president of revenue cycle transformation for Atlanta-based Piedmont Healthcare: "The best way to mitigate the risk of a billing dispute is to ensure the patient knows their benefits and expected out-of-pocket costs for the services they are receiving prior to service. At Piedmont Healthcare, this is done through ensuring we have an accurate order for the service that will be performed as well as the correct insurance information. Whenever possible our team members leverage this information to identify the patient's expected liabilities through an estimate and then communicates this information to the patient during scheduling, pre-registration, and/or at the time of registration."
More articles on healthcare finance:
CMS invites hospitals to participate in price transparency call
New Texas surprise-billing law may strip protection for some patients
A great attitude, agility and critical thinking: The qualities 8 healthcare leaders look for in an ideal revenue cycle team member