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With seemingly constant changes in the areas of technology, regulations, and reimbursement-to name only a few-providers are constantly required to modify processes to ensure both efficiency and effectiveness. Amidst this turmoil, high-performing revenue cycle hospitals attempt to go the extra mile by creating patient-friendly processes aimed at improving the overall patient experience.
Enhancing the patient experience requires that hospital revenue cycle leadership and staff be simultaneously inquisitive, responsive, innovative, and flexible. High-performing revenue cycle hospitals have and continue to make tangible improvements to their revenue cycle processes. Although there is no set formula for making improvements, many hospitals are refining processes in similar ways.
High performers generally use formalized structures to obtain stakeholder input, target improvement efforts around those areas of the revenue cycle with greatest effect on the consumer's experience, and rely on widely recognized improvement methodologies as a means to examine and redesign processes.
Most executives with high-performing revenue cycles have very specific ways they leverage relationships, focusing at the organization, consumer, physician, and payer levels around process improvement needs.
Typically, hospitals and health systems with high-performing revenue cycles rely on two types of teams to address process improvements. The first type is a team that performs oversight functions. Members monitor and evaluate key financial and revenue cycle metrics, with an emphasis on identifying trends and developing overall strategies for improvement. Typically this team is led by the CFO or a senior revenue cycle executive and includes directors or managers from the key revenue cycle departments, such as scheduling, registration, financial counseling, billing, and customer service. The team typically meets at least once per month.
The second type of team is project based. These teams focus on a specific area of the revenue cycle or are specially created to address a particular issue or task, such as managing response to a new software implementation. Regardless of whether the project-based team meets routinely or on a temporary basis, it generally includes participants from financial service areas as well as IT, physician relations, regulatory compliance, and/or clinical departments. Most high performers also have periodic mechanisms in place for soliciting employee input or feedback into processes.
Research shows high performers tend to have fewer overall revenue cycle meetings, but more meetings targeted on specific issues than other organizations.
Case Study: Revenue Cycle Leadership Structure at Spectrum Health Grand Rapids
Exhibit: Research Finding: Revenue Cycle Teams: Design and Meeting Frequency
It may not come as much of a surprise that high performers rely on formal processes for soliciting consumer feedback around process improvements. After all, hospitals frequently use focus groups to assist in setting strategic direction, enhancing services, and gauging community perceptions of the organization and its programs.
What is notable is the frequency and depth to which individual organizations involve patients in their revenue cycle activities. High performers often use focus groups when attempting to create more consumer-friendly bills. Typically, patient focus groups will be convened to provide input at the time that the initial bill redesign begins as well as throughout various stages of the improvement process. Ultimately, "approval" of focus groups is often sought regarding final design edits.
Although many focus groups, such as those involved in bill redesign, tend to be temporary and project-specific, some high-performing revenue cycle hospitals have established patient advisory groups on an ongoing basis to assist in a variety of areas, including revenue cycle.
Case Study: Patient Advisory Councils at Spectrum Health Grand Rapids
Exhibit: Research Finding: Use of Patient Focus Groups
To make the most of revenue cycle relationships with physicians, high performers make communication a high priority. They typically collaborate on the content of patient scheduling forms and surrounding processes to support consistent expectations around the gathering of patient insurance and clinical information. They also routinely solicit feedback from physicians and their office staff to ensure that their needs are being met.
As one example, when high-performing Iowa-based Henry County Health Center redesigned its business processes, it worked closely with its community physicians. The organization sought input from physicians regarding changes to the hospital admitting and registration processes, and it worked with them to develop similar policies around discounting services and charity care. Most important, Henry County Health Center kept physicians informed of how process changes would affect their patients. This collaboration has been integral to the revenue cycle enhancements.
Some organizations view revenue cycle and physician relations as so important to success that they have even developed systems to support integration within their organizational structure.
At HCA's Redmond Regional Medical Center, a high-performing 230-bed acute care facility located in Rome, Ga., relations are supported through employment of a physician development representative. As a liaison between the hospital and its physicians, the physician development representative carries responsibility for routinely visiting physicians and their staffs to assist with any revenue-cycle-related problems that may be occurring. Issues may include difficulties associated with scheduling patient appointments or the timeliness or accuracy of either party when sharing patient financial or clinical information.
At least quarterly, the physician development representative, accompanied by representatives from Redmond Regional Medical Center's scheduling/ registration department and HCA's regional customer service center, holds physician luncheons. At these get-togethers, physician office staff and hospital personnel discuss issues and concerns and brainstorm potential solutions. If not solved immediately, problems identified are addressed on an ongoing basis.
Case Study: Physician Dynamics Support Seamless Patient Experience at Geisinger
High performers are more likely to routinely communicate with payers about payment issues or technology processes than others. During site visits, all of the high performers told interviewers that they routinely engage in scheduled and impromptu communications with their largest payers, whether by phone or in person.
The focus of these conversations typically is on ways to reduce the number and causes of payment denials. Frequently these exchanges are either led by or include the executive in charge of managed care contracting, and are supported by revenue cycle personnel who can provide the necessary data and, in some cases, clinical staff.
Some of the high-performing hospitals also work collaboratively with insurers to electronically exchange data, thereby enhancing both the timeliness and quality of shared information and reducing impediments for payment. Clearly, much is being done to improve interfaces between hospitals and insurers.
That said, many of those interviewed at the high-performing revenue cycle hospitals indicated that insurers generally are more interested in transaction flow issues than consumer-focused practices. Several high performers reported success in getting payer attention to these areas only after locating the right party willing to engage in these discussions.
Regardless of the type of issue being discussed, high performers generally attributed their successful relationships with payers to such factors as frequent communication, a collegial mind-set, and staff willingness to view issues from the insurer's perspective.
Case Study: Redmond Collaborates with Insurers
Exhibit: Research Finding: Collaboration with Payers
High performers generally have focused their improvement efforts on such areas as front-end processes, point-of-service collections, and charity care.
First impressions matter. As such, many providers, including the high-performing revenue cycle hospitals, are recognizing that patient satisfaction and understanding of payment obligations is enhanced when increased emphasis is placed on improving front-end processes. This front-end focus includes:
Research shows high performers are much more likely than other hospitals to have made significant changes in registration, admitting, and financial counseling. It's also interesting to note that a high percentage believes investments in front-end technology and software have provided greatest financial return.
Exhibit: Research Finding: Relative Performance of Investments in Terms of Financial Return
Exhibit: Research Finding: Comparative Level of Improvement Efforts
Along with this front-end focus, most high performers are educating their patients about what their insurance covers as well as the meaning and amount of copayments, deductibles, and coinsurance. High performers accomplish this by conducting insurance verification on most procedures prior to services being rendered. Such efforts aid collection at the point of service.
The focus is on providing patients with cost estimates at the time of scheduling or preregistration and improving clarity of communications regarding payment expectations and processes. In addition, front-end personnel are being provided with significant training and scripting to alleviate any potential discomfort associated with seeking payments from patients.
Although most hospitals seek to collect patient copayments (and, in a few cases, deductibles) up front, the rigor associated with these efforts does vary by organization. Some hospitals will seek to postpone elective procedures in instances where patients do not provide payment, but most remain relatively flexible.
Regardless of methodology or process, almost all of the high-performing hospitals have indicated that they have experienced improved point-of-service collections and that, in almost all cases, patients are surprisingly amiable to such efforts.
Case Study: Improving Patient Payment at Oaklawn Hospital
Exhibit: Research Finding: Relative Use of Point-of-Service Collection
Another key focus for many high performers has been updating charity care practices. Over the past few years, virtually all of the organizations visited have modified their charity care policies and financial counseling processes.
Most high performers are attempting to more openly communicate the availability of charity care through actions such as providing brochures at registration, posting policies on their web sites, and including language referencing availability of charity care on patient bills. Also, some organizations are empowering patient access staff to identify potential recipients and administer the charity care policies.
In addition, high-performing revenue cycle hospitals generally have sought to enhance financial counseling capabilities within their organizations. Many hospitals are improving the pay, training, and scripting that they provide to financial counselors. Further, many organizations with high levels of self-pay activity or a high Medicaid population are supporting onsite availability of state and/or other third-party personnel to assist patients with applying for Medicaid, payment arrangements, or other types of funding.
HFMA views charity care as a community benefit commitment. In 2009, HFMA's Principles and Practices Board created "Sample Hospital Charity Care and Procedures." The document serves to help hospitals establish their own policies and procedures for offering charity care to their patients.Learn more.
Regardless of the particular process areas they select for improvement, high performers generally rely on proven redesign methodologies to support these efforts.
Typically, these methodologies consist of bringing together temporary, high-performing teams to examine, measure, and improve on current processes. Team composition may include revenue cycle staff, nonrevenue cycle business staff, clinicians, and process engineers. Some of the common methodologies used by high performers are Lean, Six Sigma, and Kaizen.
No common methodology is used among all high performers. In fact, in several instances, high performers even looked toward improvement approaches common to other industries but not traditionally employed in health care. Perhaps, as one revenue cycle leader noted, "The simple fact of creating a framework and a high level of rigor around process measurement and redesign is what is important."
Case Study: A Fresh Perspective on Performance Improvement at CHRISTUS St. John
Exhibit: Research Finding: Use of Process Improvement Teams
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Publication Date: Thursday, November 05, 2009
In this Business Profile, Shawn Yates, director of healthcare product management at Ontario Systems, discusses the growing challenge of managing self-pay accounts and provides insight on how providers can successfully collect patient payments.
In this business profile, Cathy Smith, leader of the revenue transformation consulting practice at The Claro Group discusses how the organization helps hospitals and medical groups reimagine their revenue cycle.
In this business profile, Deloitte & Touche LLP executives Anne Phelps, principal and U.S. healthcare regulatory leader, and Daniel Esquibel, senior manager, explain ways health systems, health plans, and physician practices can prepare for MACRA.
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Stay informed about new directions in healthcare finance. Share tools and strategies for improving performance. Be an active participant in your profession. Together, we’ll reshape the business and practice of healthcare. Join us.
Of all the transformations reshaping American health care, none is more profound than the shift toward value. Access HFMA’s Value Project to discover how healthcare finance leaders are joining this transformation.
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