Business Profile | Billing and Collections

Pandemic era requires flexible revenue cycle solutions

Sponsored by athenahealth
Business Profile | Billing and Collections

Pandemic era requires flexible revenue cycle solutions

In this Business Profile, Serene Munroe, executive director, product management at athenahealth, explains why flexible billing solutions are crucial now more than ever.

How do you help healthcare organizations?

Something we keep top of mind is how we can make our solutions more efficient and reduce our customers’ cost to collect. This is crucial for meeting their business metrics and to expand their mission and grow as a healthcare organization.

Our athenaIDX™ enterprise revenue cycle management solution is known for its ability to deliver operational success for customers. It offers tools and solutions organizations need to lower or even eliminate touch and leverage best-practice workflows that drive efficiency. Organizations are increasingly shifting to management of complex billing cases, so it is even more important to simplify repetitive functions.

What are some of the biggest challenges for healthcare organizations, and how do your service offerings help address these needs?

The market is consolidating, and healthcare organizations are dealing with increased complexity as they scale-up.

Many healthcare organizations are managing multiple types of payment models and are looking to cut costs, while ensuring they get accurately compensated for services billed. Taking on new customers, expanding provider networks and managing multiple complex billing environments at the right level quickly, efficiently and gracefully are challenges many of our customers are facing. Our solution enables the ability to add on new providers easily and manage that complexity with the right tools.

The shift to remote-based workforces during the COVID-19 pandemic has been another challenge organizations have been facing over the past year. With the remote model, different management styles and analytics are needed. Organizations are looking to ensure they keep remote employees engaged and that the quality of the work and productivity stays high.

Additionally, burnout is a big problem. Simplifying complex billing processes as much as possible for staff is important to minimize burnout.

Did you introduce new services to address changing needs arising during the COVID-19 pandemic?

Our strategy has always focused on reducing the number of touches each user must do to complete a task. We streamline workflows and surface tasks for the right staff, so there is not a lot of verbal or manual handoff needed between individuals. For remote workforces, this is even more important; you do not want employees repeating unnecessary processes.

Before the pandemic hit, we were working on a cloud-based gamification application that allows organizations to analyze their employees’ workflows in real time and boost revenue cycle performance. Dubbed athenahealth Gamify, this solution launched last September.

Employees win the game by working their tasks more efficiently and effectively than their peers. Managers can see how productive their employees are, where they are spending time and where the potential roadblocks are. It changes the culture of revenue cycle management, enabling employees to engage with their managers and peers at a whole different level. The work is not repetitive; it is fun.

Having that tool ready to bring to the market at a time when people were moving to remote work was a huge win for us and our customers. One customer gained an 18% increase in hold bills productivity and 3.3 days of output per user per month, reducing operating costs.

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

When looking at a revenue cycle solution, healthcare organizations need to make sure to look at things that will make a difference in their environment. It is important to partner with a solutions provider that is a good partner in your ecosystem who can accommodate your unique needs. Is your workforce as productive as possible and do you have the right tools to make sure that happens? Having a partner like athenahealth and solutions such as athenaIDX and athenahealth Gamify let you create best practices and consolidate workflows.

Another key consideration is scalability. Having a platform that enables the organization to scale — and being able to do it at a lower cost — is paramount.

What advice would you offer to healthcare leaders when choosing among vendors? 

I would look at how healthcare is changing. Workforces are shifting to partially or fully remote models. There is an increasing focus on value-based care arrangements. Payers are coming up with new requirements around telehealth and other new visit types that are becoming more predominant. Consolidation is increasing. I think organizations must have a partner that addresses these needs in the healthcare market. Having insight about what the business landscape will look like tomorrow and five years from now — not the previous five years — is going to be critical for success.

Can you elaborate more on value-based arrangements, and how your solutions meet needs in this area?

We have a single, integrated platform that works across many models of care. One element of our solution is our Financial Risk Manager that lets organizations manage various value-based care arrangements, so it becomes seamless for them to manage member groups with different risk models on athenaIDX. Employees have full visibility into the current status of patients and what their benefit plans are. On the financial side, they know the level of reimbursement and how claims are being paid

What are you expectations for telehealth post-pandemic?

Payers are still learning how to handle telehealth reimbursement, but we are getting to a place where people know what to expect. Certainly, providers and patients are becoming more comfortable with the concept, and the billing models are following. We are seeing stronger and more consistent reimbursement on claims for those kinds of visits. I expect telehealth is here to stay.

As healthcare organizations integrate your product or service into their day-to-day operations, what advice would you offer to set themselves up for success? 

Through athenahealth’s Advisory Services, we make sure that customer needs are met and that our revenue cycle solution is optimized for their organizations. If we see potential actionable trends in their data, we work with them to help identify the root cause and whether they need recommendations or services from our team as each customer has a slightly different model of operating. We tailor our approach depending on their needs.

Do your customers interact with each other?

athenahealth offers several forums for customer collaboration including topics such as value-based care, patient access, workflow management, and best practice tips and tricks. In addition, we facilitate community groups and host in-person user events.

What educational materials have you developed to help healthcare providers in these efforts?

We have various materials on our community portal, including training videos, webinars, documentation on new features and case studies. The industry can also stay up to date with our news on Twitter @athenahealth. Our experts are always welcoming conversations on how we can support the healthcare industry; all are encouraged to reach out. 

Serene Munroe is executive director of product management at athenahealth.

About athenahealth, Inc. 

athenahealth partners with medical organizations across the country to drive clinical and financial results. Our vision is to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all, and we are pursuing this through our medical record, revenue cycle, patient engagement, and care coordination service offerings. Our expert teams build modern technology on an open, connected ecosystem, yielding insights that make a difference for our customers and their patients. For more information, please visit athenahealth.com.

This published piece is provided solely for informational purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions by participants are those of the participants and not those of HFMA. References to commercial manufacturers, vendors, products, or services that may appear do not constitute endorsements by HFMA.

Sign up for a free guest account and get access to five free articles every month.

Advertisements

Related Articles | Billing and Collections

News | Staff Development

HFMA’s new Premium Facilitated Learning courses combine self-directed study with facilitator feedback and time for peer problem solving

Learn more about HFMA’s Premium Facilitated Learning — a new line of courses — that combine self-directed study with expert facilitation in this Q&A with HFMA’s Sue Spear, director of Digital Learning and Todd Nelson, director of Partner Relationships.

News | Patient Financial Communications

Providers must furnish ‘good-faith’ price estimates to self-pay patients starting next year

A newly issued federal rule on surprise billing includes regulations designed to improve price transparency for self-pay patients.

News | Health Plan Payment and Reimbursement

The finalized arbitration process in new surprise-billing regulations appears to favor insurers over hospitals

A new rule establishes a process for resolving payment disputes between health plans and hospitals when regulations on surprise billing begin in 2022.

Blog | Coronavirus

Recipients of COVID-19 vaccine boosters won’t have to pay anything out of pocket, CMS confirms

Medicare beneficiaries will owe nothing out of pocket for receiving an authorized booster dose, and the same applies to almost all Medicaid beneficiaries and most commercial health plan members.