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How Paradise Valley Succeeds in Revenue Cycle Management

By Jacqueline DiChiara

RevCycleIntelligence.com has recently spoken with several leading healthcare experts from three Truven Top 100 hospitals – St. Luke’s, Beverly Hospital, and Florida Hospital – to garner deeper insight into a behind-the-scenes perspective regarding their revenue cycle management techniques, challenges, and triumphs. As a fourth part of this ongoing Truven Top 100 series, Neerav Jadeja, Administrator at Paradise Valley Hospital, spoke with RevCycleIntelligence.com about revenue cycle management best practices, maintaining operational efficiency and financial stability, value-based care initiatives, and how to best heighten the customer experience.

Revenue Cycle Management

Imitation is the sincerest form of operational flattery

One primary advantage of being a national, rapidly expanding 34-hospital system is the ability to duplicate and disseminate what works, says Jadeja. One strategy to improve value-based and payer reimbursement is to duplicate proven best practices within newly acquired hospitals, maintains Jadeja.

“The experience gleaned from acquiring and turning around 34 hospitals in 11 states has resulted in a number of experts on the corporate staff who are always accessible to the individual hospitals,” explains Jadeja, who confirms the large hospital system’s continued emphasis on-staff expertise resulted in a Top 100 award nearly three dozen times.

Once a best practice is recognized, Jadeja says it is expediently replicated within other hospitals for maximum revenue effect. “When we see things at one place that’s working well, we try to take it to our other facilities so we can continue to improve,” Jadeja confirms.

The healthcare industry is in a continuous state of evolution when it comes to matters of reimbursement, says Jadeja. New challenges arise on a daily basis, he explains. Seeking stability when it comes to best practices leads to successful claims processing. “When it comes to revenue cycle, if we find a way that allows us to potentially get paid on a claim through a payer, that helps,” he confirms.

Understanding the root cause of denials is an essential element of impeding frustration following claim denial, says Jadeja. In cases where an error is based on misunderstanding, such as an outpatient services being erroneously billed as an inpatient service, acknowledging personal and organizational functions and goals helps promote smooth claims processing.

“You have to figure out how to communicate with people and how to connect with people. That is a key to collecting and understanding how the different insurance companies are,” Jadeja says. Making sure those billing offices and collections offices can execute different needed functions and processes, yet cohesively remain on the same page will help eliminate a backup or incorrect claims processing, he states.

Running lean to keeping expenses low and quality high

Jadeja says sharing healthcare knowledge is what makes all the difference, especially following the implementation of the Affordable Care Act. “Being part of a larger corporation, we have experts centrally that are able to help,” Jadeja maintains. “When one facility has the best practice and they learn something, we share our information.” As the healthcare industry evolves, Jadeja says the ability to keep up is imperative to widespread success.

The leadership structure of Paradise Valley hospital and its accompanying hospital systems is simplistic in nature, confirms Jadeja. Multiple positions only simply create additional work, he maintains. “We run relatively lean from a senior leadership perspective,” Jadeja confirms. “That allows us to help keep expenses down,” he adds. Identifying and sharing core measure methods, advanced means of documentation, or strengthened physician communication strategies is a key element to proving consistently high quality care, adds Jadeja.

Heightening the customer experience with rapport

When patients are in the hospital, they are primarily concerned with their healthcare, says Jadeja. Maintaining high quality of care measures means patients are more likely to be happy, he adds. Patient involvement is key, says Jadeja. “Our excellent patient experience coordinator rounds on patients daily and helps ensure any problems are resolved immediately,” explains Jadeja. “I also round daily to ensure our nurses and other staff have what they need to provide the best patient experience.”

Jadeja maintains his staff is simply friendly instead of politically-based and their rapport is strong. “If everyone’s got this nice culture, the patient experience follows. Patients have a good experience because everyone is generally happy,” he comments. “Nothing substitutes for quality care, taking care of patients, and setting expectations.”

Future plans are in place to enhance quality care further, says Jadeja. “We are on a multi-year plan to remodel patient units and common areas and upgrade our technology to ensure our facility truly reflects the high quality of care we our providing," he adds.

Maintaining financial stability with word of mouth

Without this aforementioned quality, nothing else matters, says Jadeja. “Healthcare is constantly changing so maintaining financial stability is challenging, especially in a low-income area,” he maintains. “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.”

Communication with a billing office staff promotes understanding, says Jadeja. Guaranteeing insurance companies submit claims appropriately and receive reimbursements, instead of denials, entails active involvement to maintain smooth operational efficiency, he adds.

The best marketing strategy for a hospital or healthcare organization, says Jadeja, is simply word of mouth. When someone says they had a great experience, financial stability is enhanced, he reveals. “If you’re doing financially well at one hospital but people don’t like you in the community, eventually someone else is going to open up a hospital or provide services and it’s going to take away from your financial stability,” Jadeja discloses.

Balancing your books to keep collections running smoothly is often an overlooked concept, says Jadeja. “Understanding your financial piece is key,” Jadeja states. “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.”

Promoting stability enhances financial success

Keeping patients happy is one element of financial success. But keeping employees, payers, and professionals happy is just as important. The results are cyclical in nature as the two pieces directly interlock. “Our patients benefit from this culture of teamwork and compassion, which, in turn, benefits the hospital’s bottom line,” Jadeja maintains. Promoting a culture where people want to stay is crucial to financial success, says Jadeja.

“What sets us apart is that we have physicians and staff who are committed to the hospital’s success and stability, and not just about punching a time clock,” he adds. “Having those people that are truly vested in your facility makes a huge difference.”