In this business profile, Jason Rawlings, vice president ambulatory and revenue cycle for Cerner talks about leveraging third-party management services to improve revenue cycle health.

Jason RawlingsTell us a little bit about your organization.

Cerner RevWorksSM provides revenue management services for acute and ambulatory organizations, including large health systems, community hospitals, and physician practices, as well as outreach laboratories and diagnostic imaging centers. We offer three broad lines of service. The first is an enterprise-wide outsourcing model, which covers everything from scheduling and registration through coding and documentation, claims submission and follow-up, payment, collections, and account resolution and closure.

Our second service line delivers comprehensive business office services for the ambulatory market, ranging from claims generation through payment collection. This includes a consumer call center that takes calls from patients who have questions about statements and account balances.

Finally, we have a shared services offering in which we provide staff augmentation for clients that may not need a long-term arrangement but require some temporary help with specific projects, such as retiring legacy workdowns, liquidating aged accounts receivable, and performing eligibility verification.

What are some of the biggest challenges you see affecting healthcare organizations?

The industry faces a number of challenges; however, there are three that repeatedly come up during conversations with our current and prospective clients. The first relates to how healthcare organizations are preparing for the shift from what’s largely been a fee-for-service reimbursement environment to one characterized by alternative payment models. The Centers for Medicare & Medicaid Services (CMS) has a goal that by 2018 more than half of Medicare payments will be tied to quality. Although some may argue that the timeline is aggressive, there is no question that the shift is coming, and organizations must get ready.

The second challenge is navigating a volatile regulatory environment. We’ve seen a significant amount of new programs introduced over the last several years, such as quality reporting initiatives, penalty programs, risk-sharing models, and so on. To stay afloat amidst these pressures, organizations are having to invest in people and technology, and that can be problematic, especially if the organization is not in a financial position to afford a large outlay.

The third hurdle is with the overall shift to high deductible health plans, and the burden that’s putting on individual consumers. Each year, when insurance plans reset and patients figure out they are going to owe more money, our clients get a lot of questions about consumer responsibility, as well as requests for information, which take time and resources, putting even more cost on the providers.

How does your product or service help address these needs?

Our clients are interested in increasing revenue while controlling their cost-to-collect—with a high degree of quality. Although we provide the solutions and technology to manage the revenue cycle, what sets us apart is our high level of service and expertise, which allow us to cost-effectively achieve our clients’ goals. This is due in part because we have the scale to absorb issues that arise. For example, if a single provider runs into a problem with a particular payer, and there’s a backlog in claims processing, the organization may have a hard time absorbing the flood of payments that come in once the issue is resolved. However, we have the ability to redeploy and redirect resources to address unforeseen events, so we keep the business running smoothly.

We also make certain that our goals and objectives are in continuous and complete alignment with those of our clients in terms of approach and performance metrics. To this end, we assign a regional practice manager to each account. This individual acts in concert with the client to handle any problems and look for ways to further optimize front-, middle, and back-end processes. In certain cases, we also provide financial alignment executives, who act as peers of our clients’ revenue cycle executives. They focus on strategy, determining the best ways to improve top and bottom line metrics across the enterprise. So, even though we’re providing an outsourcing arrangement, we work in tandem with our clients to identify and capitalize on improvement opportunities to enhance revenue cycle health.

What are some key considerations for healthcare leaders when choosing this type of product or service?

Obviously, the economics are important—organizations should know exactly what they’re getting for the price. For example, is the outsourcing company responsible for accounts until resolution, or does it expect you to handle some of the follow up? Making calls and tracking down payments are a huge part of the cost-to-collect, and organizations should be clear on who is responsible for what.

There should also be defined metrics and benchmarks to which both parties agree. You should know how the outsourcing partner calculates its metrics, when it calculates them, and—probably most importantly—is the company willing to guarantee certain performance? Your partner should have some skin in the game, and there should be mutually aligned goals for higher collections, lower costs, and other key metrics. For instance, early on in an engagement, we establish benchmarks for monthly cash, the distribution of insurance versus patient responsibility, A/R days greater than 90, clean claim rates, and denial rates.

You should also seek out a partner that is committed to managing and protecting your brand within your community. We work closely with our clients to make sure our teams are interacting with consumers in a way that mirrors their approach to customer service and overall patient experience, minimizing any impact to their brand and reputation.

As healthcare organizations implement use of your product or service into their day-to-day operations, what advice would you give so they can set themselves up for success?

Culture is extremely important. To be successful, organizations have to have an appetite for change. Are you open to recommendations for improving the health of the revenue cycle? Are you willing to listen to suggestions and objectively review them? These are examples of some of the questions we ask our clients when they’re seeking this type of partnership. If you don’t have a culture that’s amenable to new practices, it can be hard to materially affect performance.

Communication is also key. Organizations should have a defined communication plan that details who the stakeholders are, what information they need, and how frequently they need it. This ensures that everyone in both organizations is on the same page and working toward the same goals. Even more important is a governance plan that outlines the guiding principles of how you’re going to do business together, implement change, and sign off on any recommendations.

Are there any educational materials you would like to share to help healthcare providers in these efforts?

Each fall, Cerner hosts a Revenue Management Symposium as a part of the Cerner Health Conference as a way to network, share best practices, discuss industry themes, and learn about new and emerging revenue cycle solutions.

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CernerContent for this Business Profile is supplied by Cerner RevWorksSM. 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: Saturday, October 01, 2016