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

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Finding a Revenue Cycle Management System for Post-Acute Care

Revenue cycle management systems designed for acute care may not offer the billing integration needed for large post-acute care companies, Landmark Hospitals CIO said.

Revenue cycle management and post-acute care

Source: Thinkstock

By Jacqueline LaPointe

- Post-acute care has become a major focus as providers, payers, and policymakers attempt to cut healthcare costs and improve long-term patient outcomes. However, the revenue cycle management space is dragging its feet when it comes to making solutions tailored for longer term care.

That was the challenge Joe Morris, Chief Information Officer at Landmark Hospitals, faced when trying to find a revenue cycle management product that would unify medical billing across seven long-term acute care hospitals, two inpatient rehabilitation facilities, and one skilled nursing facility.

“The post-acute market is especially difficult to find a product with any type of sophistication,” he recently explained to RevCycleIntelligence.com.

Joe Morris, CIO at Landmark Hospitals, discusses the challenges of finding a revenue cycle management system that align's with post-acute care.
Joe Morris, CIO, Landmark Hospitals Source: Landmark Hospitals

Revenue cycle management systems lack the sophistication to manage medical billing across several post-acute care facilities because they were designed for other healthcare facilities, Morris elaborated.

“A lot of the products that are out there started for short-term acute care facilities and were not designed for long-term acute care facilities,” he said. “We still have DRG-based billing, but the length of stay requirements around long-term acute care facilities are different than for short-term acute care facilities.”

READ MORE: Top Revenue Cycle Management Vendors and How to Select One

“Or the products were designed for critical access regional hospitals, which are a whole other entity,” he continued. “Finding something that could scale and report on the metrics that drive our business was difficult.”

Post-acute care organizations like Landmark Hospitals operate under a completely different business model compared to short-term acute care or critical access hospitals.

“Those hospitals are freestanding and they do not have a corporate ownership,” he said. “If you're a regional hospital then your architecture is one hospital, one database. That's how they see the business model.”

The one hospital-one database model does not typically apply to post-acute care organizations that operate under a corporate structure and manage several different types of facilities at once.

“When you look into more of the post-acute facilities, they're typically multi-facility organizations,” he added. “But no one designed a revenue cycle product specifically for that market. They've all been augmented from another market.”

Finding the right revenue cycle management system for post-acute care

READ MORE: What Is Healthcare Revenue Cycle Management?

Despite most revenue cycle management systems being tailored for the short-term acute care space, Morris sought a medical billing solution that would bring all his facilities under one system.

Operating each facility as a standalone database as acute care hospitals tend to do was no longer an option for Landmark Hospitals, he explained. Landmark wanted to integrate billing across its facilities to improve its bottom line.

But their legacy revenue cycle management system was holding the large post-acute care organization back from streamlining their business processes.

“Previously, we were on a legacy revenue cycle platform and each facility was a standalone database. Depending on the facility type, we would have a different revenue cycle product,” he said.

With each facility managing its own database and using its own sets of revenue cycle management tools, business processes slowed down at Landmark.

READ MORE: Post-Acute Care Orgs Lack IT, Data Analytics for Value-Based Care

“We were reconciling all the reporting data with Excel across all the different companies,” he continued. “It was a monthly process and it was very tedious. It lagged our business process having the numbers delivered in an untimely fashion.”

Morris aimed to find a revenue cycle management product that allowed him to standardize revenue cycle management and pull financial data from any of his facilities in just one click. Fortunately, he found a unique revenue cycle management system created specifically for long-term care hospitals, senior living facilities, and behavioral health providers.

Through HCS’s Interactant system, Landmark’s nine long-term care hospitals and inpatient rehabilitation facilities finally operated using the same revenue cycle management system. And medical billing became a simpler process for the large post-acute care organization.

“With everything being integrated, we can run reports directly out of the new system without having to put that data into Excel and then manually calculate all of our revenue and costs,” Morris reported.

Overcoming the challenges of integrating RCM for post-acute care facilities

While unified medical billing is showing initial success for the Florida-based post-acute care organization, Morris warned similar organizations that integration may come with several challenges.

“If you don't have a standardized chargemaster, you'd have to come up with one,” he pointed out. “If you don't have a standard vendor master, you'd have to come up with one. Those are some areas that could be tricky.”

Large post-acute care organizations should also consider centralizing medical billing and accounting to ensure a smooth revenue cycle management integration process.

“A lot of our processes are centralized. We have centralized billing and accounting,” he explained. “It's controlled at a corporate level. There's not an accountant at each of the seven long-term acute care hospitals. All the accounting staff are in one office and that's off-site.”

“With everything being centralized, it's been much easier to train and standardize the new process versus the old process. We don't have to go to each hospital and train staff. They all work in each hospital remotely.”

Post-acute care organizations with five or more hospitals should seriously consider the centralized approach to medical billing and accounting, Morris emphasized.

Large post-acute care companies should also demand revenue cycle management systems that align with their organization’s business model and goals.

From unique length of stay requirements and reimbursement structures to quality metrics and care models, post-acute care face significantly different payment and care models than their short-term acute care peers.

Revenue cycle management systems that do not align with a post-acute care organization’s business model could prevent the companies from truly bending the healthcare cost curve.  

“There's a lot of dollars that are spent there. The patients are very sick,” Morris said regarding the post-acute care space.

Developing revenue cycle management tools that cater to the post-acute care space will be key to lowering costs and improving outcomes for these high-acuity patients who are being treated in one of the most expensive care settings.

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