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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.
In this Business Profile, Eric Ward, president and CEO, Parallon Revenue Cycle Services, discusses key trends in revenue cycle management and factors providers should consider when partnering to advance their revenue cycle performance.
As one of the healthcare industry’s leading providers of business and operational services, Parallon provides a broad spectrum of customized services with unmatched scale, infrastructure, and operational expertise. Parallon partners with hospitals, health systems, and non-acute care providers to improve their business performance through the company’s deep industry knowledge and proven practices in revenue cycle; technology; workforce solutions; consulting; group purchasing, with our HealthTrust Purchasing Group; and supply chain. We serve more than 1,400 hospitals and 11,000 non-acute provider organizations, operating out of some 70 centers across the United States.
Within our revenue cycle services alone, we have approximately 14,500 employees working in 25 shared services centers servicing a combined 700 hospitals and 6,000 physicians nationwide. We provide full-service, end-to-end outsourcing of the revenue cycle, managing all aspects from patient registration through account resolution. We also offer consultative services and functional area point solutions across the revenue cycle. Our point solutions include self-pay and bad debt collections, insurance collections and extended business office services, third-party liability collections, Medicaid eligibility, and physician revenue cycle services.
Revenue cycle management is increasingly complex. Hospitals are assuming increased risk in their contracts, and there are changes in payment mechanisms taking place that are putting additional pressures on ensuring revenue integrity. At the same time, compliance is becoming more challenging, access to technology is becoming a greater differentiator in revenue cycle management efficiency and effectiveness, patients are demanding a more retail-like service experience, and hospitals are going through multifaceted affiliations with other healthcare organizations—whether it be hospitals or physician practices—that are changing their business office processes dramatically. Many healthcare providers are feeling overwhelmed, where they either don’t have the time or the depth of expertise necessary to focus on each of these areas to the level desired while continuing to focus on clinical quality and the delivery of patient care.
We provide leadership, experience, and technology to partner with hospital leadership teams and tackle specific needs, such as advancing business intelligence or ensuring compliance, or we can take the whole revenue cycle function off their plate. Currently, we provide full-service revenue cycle operations to more than 225 hospitals.
We also help to reduce cost pressures—on average, our clients see a 10 to 20 percent reduction in costs—and, in many instances, we boost net revenue from 1 to 4 percent.
So we’re pleased to provide more capabilities to their operations while adding value at the same time.
There are a number of factors, but we believe the following are particularly important when choosing a partner.
Prioritize healthcare experience. Having walked in the shoes providers walk in is most important. How long has the leadership team worked in the provider setting? How deep is the team’s understanding of hospital operations and finance? Do leaders really understand what kind of impact their services can have on a hospital’s income statement and balance sheet—for good and ill? Where do the company’s operational expertise and best practices come from?
A management team from banking, manufacturing, or other industries simply won’t have the same perspective as those who truly understand the needs of hospitals and the industry’s particular business dynamics and regulatory issues.
Consider contribution to bigger-picture goals. Also, the vendor’s overall value proposition should align and support the organization’s vision. Reducing costs may be a key aim of the arrangement, but other factors that influence the business also should be considered, such as improving net revenue and cash flow, reducing compliance risk, driving technology improvements, and positioning the organization to respond to changes in payment and care, including integration across care settings.
Seek advancement of business intelligence. What are their analytics capabilities? How are they developing processes to support evidence-based decision making? Also, what is their track record with innovation? How will they help the organization recognize where it needs to be? An understanding of data and how to apply evidence to process improvement —whether with the vendor or healthcare organization— is necessary to stay at the forefront of the industry.
Demand customization. A diverse range of services is a distinct plus in selecting a vendor. However, hospitals also should look for a partner who takes the time to identify an approach that meets the hospital’s specific needs instead of pushing a particular package.
Align around principles and standards. Whether a vendor is providing a complete revenue cycle operation or serving as more of a business office extension by collecting bad debt or handling Medicaid eligibility, the company should adhere to the same principles and standards that the healthcare organization’s reputation was built on.
Foster effective communication practices. Another factor that’s highly telling in terms of a company’s potential as an effective partner is its eagerness to engage with its customers. Parallon’s most successful relationships are with organizations that are tightly integrated with us, from governance and communication to reporting of metrics. Simply signing a contract and handing off the business bodes less well for a hospital. Ideally, everyone workstogether, collaborates well, and focuses on results. As such, the vendor should have tools and mechanisms in place to ensure ongoing communication and accountability.
Cultural fit is imperative. Hospital finance executives should look for someone who shares their values and has a strong reputation in the industry. Also, the vendor should have a patients-first approach to delivering services. Because that’s the reason for all of this: caring for patients.
I think it’s also important to see how companies serve current customers: What do their core values look like in action? Do they pride themselves on delivering top-quality service? Do they have sound quality controls in place in all areas of their business? Do they treat people with respect and appreciate the hospital’s mission?
These types of considerations are as important, or even more so, than the financial equation in selecting a partner, especially with a large-scale outsourcing agreement.
Parallon offers a number of insights through white papers and case studies covering a variety of healthcare business topics.
Publication Date: Monday, September 01, 2014
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.
Converse and network with your peers around vital topics.
Drive down costs while improving quality in a reform environment.
Receive expert insights and how-to action to achieve and maintain peak revenue cycle performance.
Access expert insights on financial forecasting/planning, strategic partnerships, capital allocation, and more.
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