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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
Being a revenue cycle leader in health care is becoming an increasingly complex and challenging job. Leaders must prepare their organization's revenue cycle operations for an uncertain future, while using fewer resources and continuing to improve performance. The impacts of healthcare reform, evolving payment methodologies, and new regulatory requirements add a level of complexity that is enough to make a revenue cycle leader's head spin. Consider just a few of the imperatives faced by revenue cycle leaders, and their related action items.
Preparing for value-based payment systems and accountable care. The value-based system of payment for health care is quickly becoming a reality, with deep implications for the revenue cycle. Patients who are members of accountable care organizations (ACOs) must be tracked and managed differently throughout the revenue cycle process. Meanwhile, new bundled payment arrangements are also having an impact on operations. Depending on the structure of the bundled payment model, there can be varying levels of complexity associated with submitting and adjudicating claims and distributing payments. Revenue cycle leaders must think strategically as they proactively prepare their operations for still-evolving payment structures.
Improving business intelligence. Many healthcare organizations have invested heavily in revenue cycle information systems. These systems have captured more data, but any organizations have yet to produce new actionable information to improve decision-making. Revenue cycle leaders play in important role in connecting financial data with clinical data, with the goal of improving the overall value delivered to patients and the community. Leaders will need to play an active role in the evolution from traditional planning and reporting on key performance indicators to driver-based analytical capabilities that support strategic decision making.
Continuing to enhance revenue. Optimizing collection performance and minimizing revenue leakage have long been focus areas for revenue cycle leaders. In the current environment, it is critically important that providers claim every dollar due. Leaders therefore must focus on fine tuning areas such as clinical documentation, denials management, and patient financial clearance processes.
Driving efficiency in revenue cycle operations. Providers are facing relentless reimbursement pressure, which is causing many organizations to sharpen their focus on cost cutting. The revenue cycle is becoming a popular target for CFOs, given that these operations often represent a large budget line item. Leaders must do more with less, and many are focused on maximizing productivity by redesigning and streamlining work flow. Another common strategy involves driving economies of scale through consolidation and centralization of revenue cycle operations.
Addressing the need for pricing transparency. Recently, the media has turned its spotlight keenly on variations in healthcare prices. Leaders must focus on developing defensible pricing strategies and adjusting the charge description master in the face of pressures to increase transparency.
The challenges facing revenue cycle leaders are as demanding as they have ever been. Successful leaders will be those who think strategically and plan proactively, while motivating and managing their teams through turbulent times. It’s a tall order—and an exciting challenge.
Andrew Adams is a senior manager in Ernst & Young LLP’s Advisory Health Care practice and is based in New York.
Publication Date: Tuesday, October 29, 2013
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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