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In this Business Profile, Tom O’Neill, CEO of Xtend Healthcare Advanced Revenue Solutions, discusses key areas where organizations risk revenue leakage and ways they can use outsourcing to better protect cash flow and support accurate payment.

Tom O'Neill, CEO of Xtend Healthcare Advanced Revenue Solutions, talks about areas where organizations risk revenue leakage.Tell us a little bit about your organization.

Xtend Healthcare Advanced Revenue Solutions is the fastest growing healthcare revenue cycle solutions company in the industry. We provide a comprehensive portfolio of end-to-end revenue cycle services up to and including full outsourcing of the revenue cycle: We offer extended business office outsourcing for third-party receivables or self-pay balances. We provide computer system conversion support and legacy system cleanup work—this has been a big part of our engagements over recent years, because so many hospitals are going through system conversions. We provide outsource coding. In addition, we offer training and consulting on all aspects of the revenue cycle and health information management (HIM) assistance.

Our goal in every engagement is to maximize cash flow, expedite accounts receivable, and correctly handle adjustments. We get to the root cause of why receivables aren’t being paid and address those underlying issues, whether they are related to process or technologies.

What issues are you seeing that keep hospital revenue cycle leaders up at night?

Any number of things! ICD-10, if implemented, will be a big challenge for many organizations this year, as adjustment to the new system is likely to result in significant payment delays and much greater need to rework claims. That’s why it’s so important for revenue cycle leaders to focus on supporting clean-claim processes and preparing their coders now, before the change. Also, a strong balance sheet and cash on hand will be important to fall back on when slowed coding and claims resubmissions cause payment delays.

Compounding these challenges, the implementation of ICD-10 is expected to increase staff turnover and accelerate the number of coder retirements, as the workforce encounters the challenges of adapting to the new system’s higher demands for specificity. Focus will continue to be on recruiting new staff and elevating the training and development of existing staff to ensure readiness of appropriate coding resources.

Another challenge facing many revenue cycle leaders is managing system conversions to support the transition to an electronic health record (EHR). The benefits of EHR conversion are great, as most of the new systems are data driven and drive workflow to the front end of the revenue cycle to support clean-claim submission and accurate charge capture up front, versus traditional legacy systems that focus on follow-up on the back end. However, for conversions to be successful, organizations also need to implement many process changes, train front-end staff to adapt to the new roles they will be playing, and recognize opportunities to optimize the new system. At the same time, the attention of revenue cycle leaders is divided, because they must still manage collections of existing receivables on the legacy system. This mixed focus can make the period of time up to and immediately after system go-live particularly challenging for managing workflow.

In addition, organizations are still trying to recognize the full impact of the Affordable Care Act. There are many new insurance plans, changes in patient eligibility and coverage, and shifts in payer mix. And I haven’t even touched on the many challenges of shifting payment models under value-based care.

How is Xtend helping healthcare providers to manage this complexity?

What all of these issues have in common is the risk of revenue leakage from suboptimal processes and errors by individuals. With our experience and expertise, we help healthcare organizations identify the right areas where they should focus their efforts, identifying opportunities to optimize performance through process redesign and providing training that supports adoption of industry best practices.

With every engagement, we begin with a deep dive and examine the current state of the organization’s revenue cycle. Then we customize our approach to the client’s particular needs. For example, when an organization is in crisis, we may provide an intensive and comprehensive outsourcing approach to quickly bring in cash so the hospital or system survives. When an organization is stable and the goal is to improve, we provide consulting assistance or partial outsourcing as needed. For example, the revenue cycle may be functioning well, but a system conversion has brought new opportunities for improvement. We can provide the expertise to help leaders understand and address these opportunities.

We also commonly help organizations move toward enterprise integration. We recently worked with a 12-hospital system to merge multiple individual revenue cycles into one shared revenue cycle. Other times, a hospital just needs training due to staff turnover to ensure consistency and efficiency of workflow.

What types of partial or full outsourcing arrangements do you typically develop?

The client organization’s goals drive our work. For example, small critical access hospitals are often located in communities where it can be difficult to recruit staff and leaders. As such, we might place an experienced leader on-site to interface with the CFO, HIM director, case management, utilization review, admission, and registration staff to improve processes and systems. Then we might flow billing and collections through one of our four service centers.

Religiously affiliated hospitals, which often have missions that support community first, are frequently looking for solutions where they don’t have to cut jobs. In such instances, we will typically retrain their employees and place some of them within their service center over time for a better cost model.

What are some top questions organizational leaders should ask when choosing the right partner for outsourcing some or all of their revenue cycle services?

Perhaps the most important questions to ask any potential business partner revolve around data security and compliance with data-sharing provisions. A data breach could impact thousands of accounts and have dire consequences. Are all file and database servers encrypted? What about laptops and desktop computers? Are protections in place to ensure that access to patient-identified data is limited to what employees need to perform work duties? When was the last time the vendor went through a data security audit? At Xtend, we use Dell SecureWorks, which is recognized as a top IT security service provider and represents Fortune 500 companies. This state-of-the-art technology allows us to help our clients protect valuable customer and employee data.

Also, research the technology tools the partner will be using. How well are technologies integrated into their workflow process to ensure the partner provides timely, consistent, and effective resolutions of receivables?

Finally, it is important to understand how performance during the engagement will be monitored and reported. What type of reporting does the company provide? How transparent is it?

Where can readers learn more about Xtend Healthcare?

Basic information about our services can be found on our website. But I would also welcome an email directly to answer questions about a particular situation.

Xtend Healthcare Advanced Revenue SolutionsHFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. Business Profiles are funded through advertising with leading solution providers. Learn more.

Content for this Business Profile is supplied by Xtend Healthcare Advanced Revenue Solutions. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA. 

Publication Date: Friday, May 01, 2015