Jim Zuran's take on clinical pathways, operations within revenue cycle

Jim Zuran serves as the vice president of revenue cycle operations and client services at HealthRise Solutions, a revenue cycle management company.

Mr. Zuran will be on the panels "How Focusing on Transparency and Access Can Drive Revenue Cycle Performance" and "Key Performance Indicators You'll Need to Measure Your Revenue Cycle in the Next 5 Years" at Becker's 7th Annual Health IT + Revenue Cycle Conference, which will take place in Chicago Oct. 4-7.

To learn more about the conference and Mr. Zuran's sessions, click here.

Question: What are you most excited about right now, and what makes you nervous?

Mr. Jim Zuran: Excited: continued partnership and transparency with our contracted managed care payers. I'm also excited about [Livonia, Mich.-based] Trinity Health's continuing partnership with Qodex, a Rise family company, to bring technological solutions to persistent challenges facing every hospital system (i.e., PRN staffing and denials mitigation). Nervous: lack of partnership and transparency with our contracted managed care payers. Labor cost is another area that is causing sleepless nights due to the pandemic woes. Additional concerns from a federal level/perspective is price transparency and the No Surprises Act. Creating exact/accurate patient estimates can be challenging on the inpatient side (and outpatient surgical if there are complexities during and/or post-procedure). While consumers can price shop a television at big box retailers, the same may not necessarily hold true to the exact dollar in healthcare. The federal government continues to scrutinize healthcare (fairly at times), but doesn't fully understand the complexities involved (let alone holding the payers equally responsible).

Q: How is your role evolving?

JZ: I see my role as fairly unique within the revenue cycle space due to my prior life role as a clinical social worker while working at NYC Health + Hospitals in New York City. This has allowed me to focus more on clinical pathways and operations that cross and meet with revenue cycle. For example, opportunities to improve emergency department treatment and release with elective ambulatory follow-up, as opposed to placing patients in observation to a 20th century "rule out x" when patients aren't medically complex.

I also see my role becoming even more closely aligned with our internal payer strategies/managed care contracting team to optimize contract language to better safeguard our ministries (Trinity refers to our hospitals as ministries), so we can continue to better support the communities we serve. 

Q: How are you thinking about growth and investments for the next year or two?

JZ: Growth through increasing opportunities for a narrow network with our contracted managed care payers (separate from ACO) and exploring opportunities for a direct bill to self-insured employers to help improve patient volume(s). Investments are carefully scrutinized to ensure opportunity to further automate processes and workflows to save on labor cost.

Q: Where are the best opportunities to integrate tech into finance operations and the revenue cycle?

JZ: Increased focus on consumerism and making it easier for our customers/patients to self-schedule and register (with verification happening behind the scenes to keep denials low). Enhanced managed care payer contract load in Epic to mitigate underpayments and ensure accurate patient estimates.

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