Expert Revenue Cycle Management Advice

Late last year, Becker’s Hospital Review published 10 RCM tips they received from industry experts throughout 2016. With the seemingly ever-changing landscape in healthcare and RCM specifically, the need for expert advice has never been greater. We simplified the list a bit and included the pieces we found most useful:

1. Self-pay collection strategy is top of mind for CFOs and revenue cycle leaders.
Hospital and physicians groups will ultimately get stuck holding the bag for self-pay collections. Without patient-forward technology and processes and staff trained to implement and manage them, hospital’s risk losing revenue by simply not being prepared to engage the patient in the easiest and most friendly manner.” – Brad Baldwin, Vice President of Extended Business Office Services at MediRevv

2. RCM is a big picture role. “Getting the bill out and collecting it are critical, but so are having the analytics in place to ensure you are collecting what you’re supposed to collect, making sure contracts are paid at the level they’re supposed to be paid, and ensuring that coding is accurate so it won’t be denied later. It’s a big-picture role.” – David Boggs, Head of WK Advisors

3. To be effectively data driven in RCM, the whole ship must turn.
“If we, as a healthcare industry, want to reduce the per capita cost of care, which is a primary goal of the triple aim initiative, healthcare organizations must start harnessing the power of analytics to facilitate data-driven, evidence-based revenue cycle decisions. What is often forgotten in this process, however, is that these technologies also require the buy-in from company leadership, who help to foster a culture that embraces information as an indispensable ingredient of the decision-making process. Only then can analytics tools reach their full potential with RCM initiatives.” – George Dealy, Vice President of Healthcare Applications at Dimensional Insight

4. Strike the balance of patient satisfaction and the bottom line.
“This current transition period [in healthcare] could become a hodgepodge of increasing bad debt levels, declining cash flow and dissatisfied patients. The logical course of action would be to utilize remote billing solutions from a trusted billing and collections partner to ensure that all insurance claims and deductibles will be billed as well as any outstanding accounts receivables. This would enable provider practices to operate smoothly and also ensure the continuation of a positive patient experience. It’s also valuable to note that during this transition stage; protecting your bottom line is just as critical as ensuring a positive patient experience.” – David Hamilton, CEO at Mnet Health Services

5. Documentation is king.
“By promoting and affecting positive change in overall physician documentation patterns as part of a clinical documentation improvement program — especially helping physicians recognize and understand the medical record serves as a communication tool for all healthcare stakeholders (including the patient and payer) — healthcare organizations can prevent denials and also reduce the time and effort required to rework recoverable denials.” – Glenn Kraus, Director of Enterprise Solutions at ZirMed

6. Knowing where your patients are is even more king.
“For our hospital, about 70 percent of the funding is activity based, so it’s based on the patients we serve and the clinical diagnosis and the case mix index. So it’s really important for us to capture the right documentation right upfront on admission — the postal code, zip code, where the patient is from — because that’s how funding comes back to us, and it floats through a system of clinical documentation, physician documentation, medical record.” – John Kurvink, Vice President of Corporate Services and CFO of Georgian Bay General Hospital in Ontario, Canada

7. There is a bridge to gap in technology when shifting from volume to value.
“Fee-for-service and value-based reimbursement are fundamentally different. Organizations will likely be managing dual financial systems for a number of years, if not longer.” – Jon Melling, Partner at Pivot Point Consulting

8. Clinical staff must be educated and supported in value-based care.
“When healthcare professionals think of value-based care, they think of reducing variability, participating in shared savings and really leveraging evidence-based care and best practices. All of this is going to increasingly involve the clinical staff and that needs to continue and accelerate. To effectively accomplish this, organizations must educate and support clinical staff.” – Dan Mowery, Executive Director of Industry Relations and Market Intelligence at McKesson Technology Solutions

9. Focus on the patient experience from price transparency and cost estimates, to more self-service options.
“My advice would be to focus on the patient experience, and make it the driving force behind projects you take on. Price transparency is our biggest one lately. The healthcare industry needs to move this topic to the front of conversations with patients. Let them know what to expect in a way that’s meaningful to them. We recently started giving patients out-of-pocket cost estimates. I also would recommend keeping an eye on self-service technology — apps that let patients self-schedule and do other things. It’s the way things are going in the future.” – Jon Neikirk, Assistant Vice President of Revenue Cycle for Froedtert and the Medical College of Wisconsin

10. Work smarter.
“Ultimately, the end goal in RCM is working smarter, not harder. Hospital staffs are routinely stretched thin. Intelligently designed analytical tools are geared towards highlighting opportunities and outliers, and focusing staff attention to the most impactful workflow and resolution strategies.” – Tom Schaal, Director of Product Management at MedeAnalytics

We are very interested in your expert RCM advice for 2017. What tops your list?

Read the original article.

Source: Becker’s Hospital Review


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