An hfm Web Extra

Loren Buysman

When is the ideal time to make a change in an organization's revenue cycle management system, particularly in an ever-evolving environment? Although it's easy for most healthcare finance leaders to recognize the need for change, knowing exactly when to make the move often keeps healthcare leaders a bit baffled. The key to success? Initiate change at the first inkling of struggle, instead of waiting and being forced to deal with serious issues such as financial difficulties, aging or failing technology, or the inability to deal with emerging industry requirements.

How do you know when it's time to get started? It's likely time to reinvent revenue management processes if your answer is yes to any of the following questions. 

  • Is your organization providing care without a full understanding of reimbursement or payer responsibilities prior to care-and consequently, not fully collecting reimbursement for services delivered?
  • Are problems being discovered far too late in the process, making it difficult or impossible to implement worthwhile solutions?
  • Is your organization dedicating a great deal of manpower to complete routine and repetitive revenue management tasks?
  • Are a large number of claims being produced that require rework or that do not get paid at all?
  • Is your organization failing to offer consumers the information they need to make intelligent choices about their care and its costs?
  • Are consumer demands for online functions that enable them to register, schedule appointments, and view test results being met?
  • Is information integrated across the care continuum, so that consumers and caregivers to can make intelligent choices about care and costs?
  • Are staff members making costly mistakes simply because it is too difficult to access needed information from the disparate systems that are in place?

After considering such questions, Cathy Dougherty, assistant vice president, revenue management at Gwinnett Health System, Lawrenceville, Ga., decided it was best for her organization to get in front of the curve.

"From a business perspective, we knew for a long time that we were working with a revenue cycle management system that was built for a fee-for-service world, while we were living in a new world," Dougherty says. "The system just was not good at adapting to changes in the payer environment."

After initiating the move toward a reinvented revenue management paradigm, leaders must develop an overarching change management plan. The plan should fully leverage IT as a tool to improve operations, enhance communications, and bolster financial results.

To begin the planning process, it's important to take a holistic view - making sure that clinical, consumer, and revenue management information technology strategies are tied into one cohesive plan.

Taking a broader approach will influence what's needed in an information technology system. Instead of merely looking for a system with the best analytics or the best clinical integration or the best patient access functions, it's important to choose a system that marries all of these capabilities together.

It's also important to look beyond today's systems. Next-generation systems should be capable of improving the economics of care by automating financial processes and connecting key healthcare players: hospitals, payers, financial institutions, and consumers.

Next-generation solutions also place a significant emphasis on upfront processes. With these systems, all information needed to support patient care decisions, help meet regulatory requirements and collect full payment for services delivered is collected at the beginning of the process. Tasks that were typically performed after care was delivered are now handled at the first patient interaction.

For more information, see Loren Buysman, "5 Things to Look For in a Next-Generation Revenue Cycle Management System," hfm, August 2010.

Publication Date: Wednesday, August 04, 2010

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