Improving revenue cycle management is a key focus for hospitals and health systems as they navigate the shift to value-based care and patients take on more financial responsibility for their care.
Becker's Hospital Review asked RCM leaders at some of these organizations to share their improvement plans for the rest of 2019. Read their responses below, presented alphabetically.
Editor's note: The following responses were lightly edited for length and clarity.
Nicholas Economides, MD
Associate CMO of revenue cycle at Baptist Memorial Health Care Corp. (Memphis, Tenn.)
We formed an internal physician advisory service line that challenges every clinical denial issued by Medicare Advantage plans, assuming they met admission guidelines. We first covered a few facilities. In July, though, we extended coverage to the system. The expectations are: to review every denial for Inpatient cases; overturn initial denials via a peer-to-peer communication; document in the EMR an appeal note based on clinical information; conduct secondary reviews and accept observation stays only if appropriate; [and] assure that observation cases do not exceed a 48-hour [hospital] stay. Early results have shown a 40 percent turnover rate for inpatient cases and a 25 percent acceptance rates for observation cases. There was also a 2 percent reduction of observation rates over 48 hours.
Michele Tynes Napier
Chief revenue officer of Orlando (Fla.) Health
We are transitioning all of our entities to Epic next year. But some of the other things we are working on is a new team in access in the financial clearance/pre-early out space. We are seeing more high- deductible [health plans] and higher out-of-pocket [costs], so not only estimating the out-of-pockets for the patient, but developing a plan with them and keeping them informed through the billing process.
Chris Thomas
Corporate vice president of revenue cycle and central business office at Scripps Health (San Diego)
Over the next year, Scripps Health's revenue cycle is focused on transforming our operations by embracing leading-edge technology to drive greater automation and enhanced data analysis to capitalize on areas of opportunity. By doing so, we know we can positively impact our priorities as it relates to our patient financial experience, revenue integrity, clinical documentation improvement, and ultimately, our ability to ensure our revenue can continue to support our ongoing mission to our community.
Brian Unell
Vice president of revenue cycle transformation and integration at Piedmont Healthcare System (Atlanta)
For the remainder of this year we have three system replacements/upgrades scheduled which will improve our revenue cycle: enhancing our coverage, eligibility, benefits and authorizations solution; improving our claims clearinghouse; and upgrading our version of Epic to 2018.