Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

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Top 7 New Strategies for Revenue Cycle Management Excellence

“If you’re bringing in a certain amount of revenue, you can’t have expenses that exceed that revenue. It’s seems very basic but people don’t look at it that way.”

- Money may be the root of all evil, but it is also the root of the healthcare industry.

revenue cycle management claims management

Revenue cycle management, based upon the straightforward notion of continuously staying in the black, is about getting paid, and expediently so.

Within the healthcare space, successful revenue cycle management means many parties – patients, patients’ families, physicians, nurses, billing departments, CFOs, and healthcare payers, to merely name a few – come together at various points in time, with money fusing them together.

Here are leading healthcare experts’ 7 best tactics to help make sure your revenue cycle management efforts are focused, logical, and financially solid for 2016.

Begin at the beginning

“From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration. That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible,” said Gary Marlow, Vice President of Finance for Beverly Hospital and Addison Gilbert Hospital, to RevCycleIntelligence.com.

“The last thing you want is getting a claim submission kicking back to them then having to work their way through the institution. If you get the information up front in as pleasant a manner as possible, it saves heartache for the patient and family if the claim is processed and cleared in a judicious manner.”

“We often have recurring patients. They may start with an ER visit, end up in the OR, and ultimately, on a patient floor. If we take care of that benefit understanding from the very beginning, they can make wiser choices for themselves as they go along,” stated Lynn Giddens-Branscum, Revenue Cycle Director at Wise Health System, to RevCycleIntelligence.com.

“We are in the process of changing the point where that type of contact happens with the patient. Previously, that conversation wouldn’t happen until the patient had met with their physician and had a procedure scheduled.”

“We are really trying to recognize the challenges our patients face and measure and weigh those against challenges organizations face, related to bundled payments and just everything as a whole. I don’t think any individual piece of the revenue cycle makes or breaks an organization. It's the revenue cycle as a whole.”

Go back to revenue basics

Revenue cycle management success is about the art of simplicity, asserted Neerav Jadeja, Administrator at Paradise Valley Hospital, to RevCycleIntelligence.com.

 “If you’re bringing in a certain amount of revenue, you can’t have expenses that exceed that revenue. It’s seems very basic but people don’t look at it that way.”

“Healthcare is constantly changing so maintaining financial stability is challenging, especially in a low-income area. … We are always looking to ensure we are reimbursed for the services we provide and to improve our communication with our payers on claims to ensure financial stability and balance our large charitable care contributions.”

Use data to tell your story

“There's little you can often do in the short run around volume and rates of payments which shifts the focus to the cost side,” stated Sally Mason Boemer, Senior Vice President of Finance at Massachusetts General Hospital, to RevCycleIntelligence.com.

“A lot of my time and efforts are making sure that people understand that environmental context. … It's very hard to motivate people to focus on reducing costs if they're not confident that you're collecting every dollar that you're owed for the work you are doing.”

“As you're trying to change quickly, you need data to craft your story and tell it to your workforce and bring them along with you on that journey. When you're working outside of the organization, I think there's also the expectation of more transparency and understanding what the cost of healthcare is and why the system works how it does.”

Keep going back to the drawing board

“We address expenses on an ongoing basis. It’s not a one-time event we look at every couple of years,” explained Tom Lichtenwalner, St. Luke Hospital's Chief Financial Officer, to RevCycleIntelligence.com.

“We have established Medicare cost-reduction initiatives, and our goal is eventually to break even on the Medicare side. Our thought is: if Medicare is our biggest customer, which it is — it’s probably 40 percent of our business — shouldn’t we at least break even? If you can’t make money off your biggest customer, it puts a strain on the rest of the organization.”

Reject a maintenance mode mentality

The purpose of the revenue cycle is to maximize cash flow and net revenue. For that reason we are always looking to improve performance. We will never be in maintenance mode. We will always look at some way to squeeze it a little bit more, get more efficient, reduce cycle time and waste,” remarked Rick Lyman, Vice President of the Revenue Cycle at Advocate Health Care, to EHRIntelligence.com.

“What we’re really focused on is net-revenue improvement. It’s all about net-revenue, to be honest. It’s improvement on denials, underpayments, and reducing bad debt. Also, we need to be efficient. We don’t have the luxury with reimbursement being down and cuts to Medicare of overstaffing. We always need to cut cost and we’ve got to serve our hospitals.”

Consider a consolidated billing program

"Historically, the revenue cycle has been regarded as overhead, support or shared services – basically an operational expense to be managed and minimized as much as necessary. Given the complexity of healthcare and the importance of consumerism, the industry really needs to begin to look at the revenue cycle as a strategic business unit,” stated Jeff Hurst, Florida Hospital’s Senior Vice President of Finance, to RevCycleIntelligence.com.

“Typically, the whole post service billing process is very confusing for a patient. They get multiple bills from multiple providers. You always get the patient who calls in and says, ‘I have five bills from five different providers and I don’t know who I owe. Can you help me?’”

“We’ve got to move more and more toward a streamlined billing process that’s simple for the patients to understand in terms of helping them satisfy their obligation. We need to become more flexible on the back end. This idea that one size fits all isn’t the case.”

Merge revenue cycle with supply chain

For the majority of most provider organizations, supply chain management and revenue cycle management initiatives “function in silos, occasionally responding to anecdotal evidence to make improvements in the processes linking the two areas,” write researchers in a study from the Health Sector Supply Chain Research Consortium.

“Hospitals and health care systems that become proficient in managing the revenue environment achieve strategic advantage by reaching their financial goals and assuring a stream of revenues to support their clinical efforts.”

As money indeed makes the healthcare industry go ‘round, it is hopeful the aforementioned 7 strategies can help yours go ‘round more efficiently.

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