5 key observations on managing revenue cycle performance

At the Becker's Hospital Review 3rd Annual Health IT + Revenue Cycle Conference in Chicago on Sept. 22, 2017, healthcare industry experts sat on a panel discussing revenue cycle performance.

The panel included Vice President of Revenue Cycle Management at San Diego-based Sharp HealthCare Gerilynn Sevenikar; Vice President of Product Management and Revenue Cycle Analytics at Change Healthcare Jason Williams; and Director of Revenue Cycle Management at Bellafontaine, Ohio-based Mary Rutan Hospital David Kelly. Sam Reynolds of Ernst & Young moderated the panel.

"I think most people are doing well with their revenue cycle management," said Ms. Sevenikar. "Most progressive providers out there are working with some sort of tool to work with patients for out-of-pocket and get this information in the hand of front line employees so they can communicate with patients."

Others need help with the payer process, authorizations and payment liability. They might get a grip on the patient payment process but don't necessarily have a collections process with a great patient experience. "Now it's to the point where patient collections are enough of the overall financial picture that you have to have some sort of patient counseling and people are still uncomfortable and the push lately is to try to get a more patient-centric point of view among folks who aren't necessarily clinical caregivers," said Mr. Williams. "As a matter of fact, progressive hospitals are beginning to call their revenue cycle administrative staff caregivers now."

Here are five observations from the panel:

1. An unexpected medical bill is disturbing to patients. Hospitals can combat an unexpected bill by sharing benefits information and estimates on how much their care will cost out of pocket. 

2. Artificial intelligence will automate many aspects of the billing process, leading to a leaner billing department. The staff who remain on the billing team will see their responsibilities change from collecting and submitting claims to vendor management and technology management. "The team members that would be left that I wouldn't replace, they don't think that way. I have to go on a multiyear training pathway to get them there. That's one of the biggest obstacles in the transition to AI," said Mr. Kelly.

3. The claims submission processes are continuously evolving and the dynamics of the workforce is changing. Ms. Sevenikar transformed her billing department with an eye to the next generation of billers — digital natives — who will be responsible for only the claims that need an individual touch with additional levels of intelligence.

"We've got the analytics over our workflow. Truly our workflow in this environment is weaving an account from one place to another and we go over a hurdle to get it from the beginning to a clean submission to the payer. And I can define those hurdles we can track and see employees [passing] over those hurdles … I want to know when my employees have the best day they've ever had," said Ms. Sevenikar.

4. Healthcare organizations are increasingly participating in value-based care and are looking at ways to deliver when their models are no longer experimental. Ms. Sevenikar's experience in California, which has a high percentage of managed care capitation, prepared her for the transition to more risk-based and value-based contracts. "I think value-based care is growing and I think doing the right thing is appropriate. We as healthcare providers should own it," said Ms. Sevenikar.

5. Many hospital executive teams gather and analyze data, but only share the data among the C-suite, leaving front-line workers in the dark. "I think the most unfair thing hospitals do is present numbers to the executives and the folks who actually do the work and make the decisions that need to be made don't have the visibility to be ahead of that. It's one of the most unproductive things you could possibly do," said Mr. Williams. "If it takes a village to make the revenue cycle successful then one of the easiest things to think about from an analytics standpoint is whether you have shared the score with meaningful stakeholders and not just administrative stakeholders sitting in the CBO."

More articles on revenue cycle management:
3 best practices for hospital revenue cycle optimization
Treating patients as consumers—the key to improving revenue cycle health
10 hospitals seeking RCM talent

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