Examining Current Challenges of Revenue Cycle Management
In an interview, revenue cycle management expert Brian Sanderson discusses the current challenges in the industry.
- This is Part 2 of an exclusive interview. For Part 1, click here.
In an interview with RevCycleIntelligence.com, Brian Sanderson, the managing principal of Crowe Horwath healthcare services group, spoke about how the healthcare revenue cycle has evolved and what new obstacles are emerging.
The challenges that revenue cycle management professionals face are evolving. The biggest change is the identification of opportunities in related improvements are much thinner now. Previously, many organizations did not update their charge master appropriately or price strategically.
“Now most of those things are gone,” Sanderson said. “Now on the CDM side it’s using the most appropriate codes, on the pricing side it’s appropriately using the lesser of clauses, on the denials side it’s the systemic small balance denials that need to be changed to in a more sweeping systemic way.”
He added that many organizations struggle to handle “ABCD.” That stands for accounts receivable, bad debt, charge capture and denials.
The Affordable Care Act is also impacting how organizations manage revenue cycle solutions, specifically when it comes to patient liability. There are a number of options when it comes to healthcare that can create complications at the front end.
“Universally what we are going to see is more people are going to have more self pay which is going to create a dynamic in the patient interaction that is going to challenge the patient satisfaction side of it,” Sanderson said. “With consumers having more say in where they go, if you go in, get shaken down for more money, have a bad experience you are probably going to look at the place across the street where they maybe pay less and receive better service. That’s going to be the dynamic on revenue cycle with a focus on patient satisfaction and self pay interaction that they haven’t seen before.”
He added that a major trend he has noticed, based on thought leaders he has listened to or had discussions with, is that everyone is discussing the “healthcare company” or the “hospital company” and not just the hospital. Healthcare organizations are now a conglomeration of different sites and step downs that can be forced together under one brand.
Sanderson used the example of a medical facility, whose brand revolves around the hospital, but still has a number of companies under that entity. The problem is that just because these organizations are under the same umbrella, it does not mean that there is consistency when it comes to operations, customer experiences and the revenue cycle. This creates “the next generation of nuance.”
Moving forward, the self pay portion is going to be the most critical trend that hospitals need to consider. While events like ICD-10 may have more importance, they are going to flare up, organizations will adjust and then they will pass. However, self pay is going to increase in popularity. It is a trend to watch, however, because organizations have not worked it effectively in the past and when you add a layer of consumerism to it you “suddenly double down on what the patient interaction is gonna be.”
