In a discussion at Becker's 11th Annual CEO + CFO Roundtable, two leaders from 3M's health information systems division — Diana Ortiz, revenue cycle senior business director, and Simone Gravesande-Joseph, consulting senior manager — discussed challenges and solutions in the healthcare industry regarding coding, documentation and revenue cycle management.
The conversation highlighted the effect of labor shortages, the need for improved technology and the importance of cross-functional collaboration. Ms. Ortiz and Ms. Gravesande-Joseph also discussed the challenges of managing denials and the challenges of receiving appropriate reimbursement from insurance companies and the need for more transparency in the industry. The discussion concluded with the importance of physician engagement and leadership in improving healthcare processes and outcomes.
Key takeaways:
1. The shortage of qualified coders and clinical documentation specialists is affecting revenue and quality metrics.
“The goal of trying to solve for revenue and quality is always a delicate balance and resource constraints make that a continuous challenge,” Ms. Ortiz said. “Prioritizing those service lines with clear opportunities should be a guiding principle to success.”
2. Implementing new technology in the revenue cycle is challenging due to limited IT resources and competing priorities.
"IT teams are quite overburdened," Ms. Gravesande-Joseph said. "... The demands on the system and the whole cybersecurity world have exploded in healthcare. There's just so much on their plates right now that it's certainly a barrier for the healthcare industry."
3. Denials management is a high priority for revenue cycle organizations, but there are challenges in addressing denials and obtaining approvals.
"Denials are a vicious cycle," Ms. Gravesande-Joseph said. "And, it consistently changes as the regulations change; you're constantly trying to catch up on what those new denials are. Having visibility at least into what areas you're getting denied in — and knowing it at the payer level — helps. Tracking those denials over time will certainly help you to address the quality of care issues."
4. Engaging physician leadership is crucial in addressing denials and improving revenue cycle outcomes.
"I've always thought it's critical for the coder and CDI to be on the same page, but it's even more important to involve the physician who's on the front lines of clinical documentation," Ms. Ortiz said. "Now, we really have this chance to show physicians the end of the story … highlighting final payment and quality outcomes. Physicians should have visibility into the volume and trends surrounding denials. Those insights can encourage physicians to be part of a proactive model and solution."