- HFMA’s Seminars will be held Dec. 5 and 6 in Chicago.
- Participants can choose from six areas of focus depending on career level and expertise: business intelligence and analytics, chargemaster, healthcare financial management essentials, Medicare cost report strategies, value-based payment, and revenue cycle.
- Learn more and register now.
Healthcare finance professionals looking for a deep dive into the most pressing issues in the industry today now have the opportunity to register for a two-day focused education at HFMA’s Seminars Dec. 5 and 6 in Chicago. Participants can choose from six sessions on various topics.
In a revenue cycle-focused session updated for this year, Sandra Wolfskill, consultant, and Lucy Zielinski, managing partner at Lumina Health Partners, will provide resources and best practices for today’s revenue cycle. The session, “Revenue Cycle Essentials and KPIs,” will include a review of the patient-friendly revenue cycle as well as discussion of how to face key challenges.
Integrated organizations need integrated processes
Merger and acquisition activities over the past several years have left many health systems with several legacy organizations still using their own processes, Zielinski said. As stakeholders are coming together to integrate care, revenue cycle managers should be looking at their processes to ensure the entire organization is in sync.
“Revenue cycle has to follow suit in being integrated so providers of care are getting paid for what they’re doing,” she said. Revenue cycle processes are different for acute care and ambulatory care, so it’s necessary to find a way to bring those processes together as care is integrated.
Key performance indicators for every stakeholder
One key idea for Zielinski is that different stakeholders should focus on different key performance indicators (KPIs). For example, a physician cares more about KPIs that determine how they are paid, such as relative value units. The front office staff cares about clean claims but isn’t as focused on margin.
“Every stakeholder group cares about different things, and KPIs have to be aligned for each group,” she said.
Patient communication is the key to consumerism
At the core of revenue cycle performance is a focus on the patient, Wolfskill said. The rise of high-deductible health plans as well as conversations around consumerism and price transparency have made for a patient population hungry for information. Healthcare organizations need to respond by talking with the patient about their financial responsibility so there are no unwelcome surprises when the final bill arrives.
“Even a ballpark or a range will help patients understand where they fit in,” Wolfskill said. “We wouldn’t be talking about this if it weren’t possible.”
Staff must draw on different skills than they have in the past, and they need to be trained to respond to patient questions. More healthcare organizations are seeing a need to set up call centers and other resources for patients to get more information about their financial responsibility, according to Zielinski.
“We talk about increasing access to care. I think we have to increase access to the revenue cycle,” Zielinski said.
New payment models also require a focus on individual patients. It’s important to identify patients with chronic conditions who fit into specific value-based payment programs and then code their care appropriately, so those patients are counted as part of the correct programs, Zielinski said.
The role of technology
The session also will focus on using technology to improve performance. Having artificial intelligence (AI) technology is essential to success in today’s revenue cycle, Wolfskill said. Automating processes can help make them more efficient and provide data that revenue cycle managers can use to improve results. However, it’s also essential to have the right people who know what to look for in that data.
“AI will find the issue for you. It won’t tell you how to fix it,” she said.
For example, AI can tell an organization which health plans are not responding to claims. A duplicate claim is unlikely to get good results; however, a conversation with the health plan could help an organization figure out where the process breaks down and take steps to remedy the issues.