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4 Things Healthcare Providers Need to Boost Agent Productivity and RCM

4 Things Healthcare Providers Need to Boost Agent Productivity and RCM

Recently, I shared six healthcare industry predictions for 2020. These trends are motivating providers to take a fresh look at their revenue cycle performance in the hope of finding ways to cut costs and boost revenue.

If you’re aiming for similar results this year, your accounts receivable (A/R) team may hold the key.

In truth, most healthcare agents aren’t equipped to maximize their time. As a result, they lose opportunities to recover revenue, and accounts languish in A/R. As providers expand their workforce without addressing common productivity drains, these lost opportunities multiply.

Meanwhile, ineffective agents lose heart and head for the door in large numbers. Providers scramble to backfill positions while scaling their A/R operations. Hiring and onboarding costs continue to rise.

Many healthcare leaders struggle with how to tackle these problems effectively. There are only so many hours in a workday (with a significant portion of an agent’s shift spent navigating IVRs or on hold with payers). Managers can provide only so much guidance and support to on-site agents, and remote agents are practically on their own. “Peak performance” must be defined within these limits.

If this is your thought process, it’s time to start questioning what’s really possible in 2020.

Here are four essentials you need to boost agent productivity, optimize your A/R operation, and transform your revenue cycle.

 

1. Workflows That Prioritize High-Value Tasks

Your investment in people should deliver the highest possible return for your organization. Are your agents dedicating most of their time to performing high-value tasks? An automated A/R environment can help them do that in two important ways.

  • Automation of workflows – Rather than being inundated with tasks that don’t require human intervention, agents are presented only with exceptions to automated tasks (e.g., insurance denials). Codified business rules can ensure high-value accounts are routed to agents in order of importance.
  • Agent schedules – This guides agents through a predetermined order of what work queues should be worked first. It schedules them to move between work queues (based on time of day and/or duration) so they can work accounts more evenly.

 

2. Shorter Payer Hold Times

Time spent on hold is one of the steepest barriers to A/R optimization, and many providers are resigned to it. What can be done to overcome IVR navigation and wait times? Agents have to make their way through the IVR, however painful and wasteful it may be, to connect with live insurance reps.

Here again, with automation and artificial intelligence, providers have a real shot at overcoming this seemingly insurmountable problem and reducing insurance hold times significantly—by up to 80%. If your system automatically navigates payer IVRs and tees up new payer calls while agents are working claims, agents can glide seamlessly from one payer call to the next. As the system performs, it analyzes call data and adjusts the neural network for the expected hold time to route new payer calls more precisely.

 

3. Agent Guidance to Promote Uniformity

All agents have procedures they must follow when working accounts. If a denial is identified, an agent needs to perform certain steps when talking to the payer. Uniformity on the front line improves performance, as agents follow established procedures that work. As performance improves across the board, so does productivity. Having a playbook that’s visible to agents while they work accounts will help them move through the follow-up process more efficiently.

 

4. Real-Time Views of Priority Accounts

The last piece of the productivity puzzle is helping agents make the most out of every payer call. As each payer call is connected, agents should be able to see on their screen exactly which high-priority claims need to be discussed on the call. The system should have a summary of those top 25 key accounts in a gadget that can be used to open the account in a separate tab. This allows an easy transition on the call and helps the agent work many more accounts for each interaction.

 

All of This Is Possible with Your Existing EHR

These transformative changes are achievable without disrupting your EHR workflows or your operation. In fact, you can fill the “EHR gap”—and get the agent productivity tools you’re missing—with a simple complement that’s designed to work seamlessly with your current setup.

You can learn all about it in our free eBook “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix.” Download your copy today, and discover the easy way to supercharge your agents’ performance and results.

 

GetixHealth Increases Claim Follow-up Efficiency by 60%

Learn how this leading RCM provider transformed its collection team's performance with the addition of a simple EHR complement.

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

6 Predictions for the Healthcare Industry and Revenue Cycle Management in 2020

6 Predictions for the Healthcare Industry and Revenue Cycle Management in 2020

The healthcare industry has seen transformational change in recent years. The ‘20s will bring even more change and uncertainty. Economic, market, and regulatory forces will continue to reshape the landscape, making it even tougher to navigate.
 
With operating margins declining 21% in 2019 (despite positive gains in 2018), providers are struggling to maintain their footing.
 
In response, many are taking a hard look at their operations, business model, and growth strategies. They’re also embracing innovation as a means of strengthening their financial health and ability to compete.
 
 
“Burdened by expensive fixed assets, redundancy, and inefficient utilization levels, health systems need a major course correction if they are to provide 24/7/365 access, shift care to virtual and lower-cost settings, manage new competitive threats, and meet rising consumer expectations. Becoming 2 to 3 percent more operationally fit each year will not keep pace with the rate of change required.” – Geoff Martin, COO & Managing Principal, GE Healthcare Partners
 
In light of this increasing complexity and financial strain, providers will need to make a bold move in 2020 to improve their operations. Below, I’ve outlined my specific predictions for 2020 and why now is the time for providers to act.
 
 

1. Reimbursements Will Continue to Shrink

Healthcare spending is growing out of control; in fact, it’s growing faster than projected GDP growth. According to the Centers for Medicare and Medicaid Services, our national health expenditure is expected to grow 5.5% annually through 2026 and account for 19.7% of GDP by 2026 (up from 17.9% in 2016).
 
This growth rate is unsustainable. Unfortunately, the budget cuts required to curb healthcare spending will likely take the form of declining reimbursements—an existing trend that will continue into 2020 and beyond.
 
In a December 2018 survey of 100 healthcare executives, 62% listed declining reimbursements as their #1 organizational challenge. In 2020, that sentiment will undoubtedly spread as providers feel increasing pressure to reduce operating costs and address weaknesses in their revenue cycle.
 
 

2. Commercial Carriers Will Continue to Shift More Costs to Patients

Expect to see continued increases in high-deductible health plans (HDHPs) and growth in insurance premiums for 2020. The percentage of workers covered by an HDHP grew to 30% in 2019—a 1% increase over 2018, but more than double the percentage covered in 2010.  This is a continuation of a trend we’ve seen since 2006; there are no signs of this abating, and this growth will continue in 2020. 
 
Insurance premiums have grown 54% in the last 10 years. The average family now must pay over $6,000 a year for coverage, making it tougher for them to pay for unexpected medical bills. According to a 2018 report, 77% of providers indicated it takes more than a month to collect any payment, and over 80% of providers reported being unable to collect $1,000+ within 30 days. 
 
These trends are readily evident in a 2019 survey of healthcare executives, in which 85% identified consumer self-pay as a concern for their organization (see below). In 2020, consumer self-pay will continue to become more prevalent and more of a challenge for providers already struggling to collect payments.
 
 
consumer self-pay, healthcare, RCM, 2020
Source: HFMA-Navigant RCM Survey (2019)
 
 

3. Retail Clinics and Telemedicine Will Have a Greater Impact

The growth of retail clinics and telemedicine, which has been a major trend over the past few years, will likely accelerate in 2020. You’ll also see an expanding array of available options for consumers. More and more large employers will set up their own worksite clinics, for example, or create special contracts with certain providers.
 
 
retail medicine, healthcare, RCM, 2020
 
 
This growth in retail, employer-based, and remote healthcare services reflects employers’ focus on productivity and retention and consumers’ desire for immediacy and ease. But as traditional providers’ patient volumes drop, this will further reduce revenue and margins, creating more of a financial strain on providers and forcing them to make changes.
 
 

4. The 2020 Election Will Be a Major Turning Point

Democrats and Republicans have differing opinions on what to do with the Affordable Care Act (ACA). Republicans want to continue to dismantle it, while Democrats would either build it back up or go with another alternative like universal healthcare. 
 
No matter the 2020 election outcome, it will be pivotal for the financial environment in healthcare. Either the uninsured will continue to grow to pre-ACA levels, or an enhanced model/new program will have to be paid for—meaning more reductions in reimbursements.
 
 

5. Patient Engagement Will Come Into Sharper Focus

When it comes to adopting new technology, healthcare providers have often lagged behind other customer-facing industries. Consumers want and expect a convenient, personalized experience across all brand encounters, regardless of industry.
 
The pressure is on for healthcare providers to move beyond traditional letters, phone calls, and portals and provide digital communication options that could help improve treatment outcomes and make it easier for patients to meet their financial obligations. Moving forward, expect to see rapid growth in patient engagement platforms that combine more of these services into one offering for both providers and patients. 
 
 

6. A/R Collector Productivity Will Become a Top Priority

Over the past few years, healthcare providers have focused on automating as many tasks as possible. Automation is key to achieving optimal efficiency, but the bigger issue (and greater challenge) is managing employees in ways that help them be more productive and effective. This is especially true in RCM, on the back end of the revenue cycle.
 
In 2020, managing A/R collector performance (whether employees are working remotely or on site) will become an urgent priority across the healthcare industry. Providers will increasingly look for ways to give A/R teams more valuable feedback and tools as a means of controlling labor costs, shortening the revenue cycle, and maximizing revenue recovery.
 
Are you looking to build an accountable, more effective A/R operation? You’ll find the answers you need in our eBook The Accountable Collector: Transforming Healthcare A/R with One Simple Fix. Download your free copy today, and start working toward a more profitable year.
 
 

 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Boost Your A/R Results — and Your Business Results — with Ease

In this brief guide, The Accountable Collector: Transforming Healthcare A/R with One Simple Fix, learn about the two big revenue drains every provider must address, and how to fill your “EHR platform gap” so you can start building an accountable collections team.

RCM Reality Check: Is There an EHR-Friendly Way to Boost Collections Results?

RCM Reality Check: Is There an EHR-Friendly Way to Boost Collections Results?

This is the fourth in a series of five articles highlighting costly RCM issues and what providers need to address them.

 

Your electronic health record system (EHR) is a big investment, and a crucial one. As the beating heart of your operation, it powers your patient services, operations, and revenue cycle. It has revolutionized the way you provide care and manage your business.

There is, however, an “EHR platform gap”—the missing piece that could be costing you substantial profits.

While your EHR system excels with registration and clinical aspects of the revenue cycle, it lacks the visibility you need as to how  your collectors are performing day-to-day. Procedural mistakes, missed opportunities to discuss high-priority claims, long hold times, too much time off the phones—all of these daily realities can add up to big losses.

To optimize your A/R operation, you need three things you don’t already have:

Is there a way to integrate these capabilities without changing your current setup or nullifying your core EHR investment? Surprisingly, there is.

 

 

The EHR Enhancement That Transforms the Revenue Cycle

If you already rely on your EHR system for RCM functions, a “bolt on” A/R workflow management platform would likely create friction by disrupting or overriding existing functionality and workflows.

This is a reasonable concern. We’ve heard it firsthand from providers who want A/R accountability but don’t want to upend their current system. We developed the Artiva Magnify™ solution specifically to complement EHR systems, work seamlessly with them, and enhance their capabilities and value.

The Artiva Magnify solution is also designed to integrate easily, with its unique mix of A/R functions (automation, communications, monitoring, and reporting) working together as part of a harmonious “ecosystem” that’s easy to adapt and maintain.

This simple addition to an existing EHR can simultaneously enable A/R teams to accomplish more with less, drive employee engagement, and boost revenue recovery—all of which create the conditions for improved retention on the front line. Together, these top- and bottom-line benefits turn A/R into the profit center it was meant to be.

 

GetixHealth needed a better way to manage its global A/R workforce. In one easy step, the company improved claim follow-up efficiency by 60%. >> Read the success story

 

 

Learn More About the Industry’s Simplest A/R Fix

As financial and market pressures increase and account volumes grow, having a loyal, motivated collections team that’s well managed, maximizing work time, and making the most of every payer call is a major advantage. But if you have to disrupt your current EHR setup to get it, you’re giving up too much.

 

Our complimentary eBook “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix” explores two of the most common A/R profit drains, the performance questions your EHR platform won’t answer, and the secrets to creating an accountable (and more effective) collections team. Download your free copy today.

 

 

Don’t miss the other posts in this series:

 

Want more insights and tips you can use to improve your financial health? Subscribe to the OS blog, and we’ll deliver them straight to your inbox.

Boost Your A/R Results—and Your Business Results—with Ease

In this brief guide, “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix,” learn about the two big revenue drains every provider must address and how to fill your “EHR platform gap” so you can build an accountable collections team.

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

RCM Reality Check: 3 Keys to Improving Your A/R Team’s Performance and Results

RCM Reality Check: 3 Keys to Improving Your A/R Team’s Performance and Results

This is the third in a series of five articles highlighting costly RCM issues and what providers need to address them.

 

If your A/R operation isn’t as streamlined and effective as you’d like, and turnover is typically high, you’re in good company. Many healthcare providers struggle to manage and retain the people who power the back end of the revenue cycle.

Perhaps you’re resigned to these realities. You’d love to help your collectors improve their performance, but there’s no way to track their daily activity. How your work-at-home collectors spend their time is a complete mystery. A manual, labor intensive and data-lacking quality assurance (QA) process offers little value.

Without effective management and support, many collectors tend to disengage. They’re not motivated to excel, or even to stay.

You could continue hiring and onboarding new collectors, setting them loose, and watching a large percentage of them leave. Or you could unleash and strengthen your team by bringing accountability to the collections process—and drive productivity and recovery rates higher and higher, even as account volumes grow.

If you’re determined to optimize your revenue cycle, accountability is the way to go. Below, we’ll walk you through the three things you’ll need to achieve it.

 

 

What If You Take the Wait Out of the Equation?

By simply enhancing their EHR host architecture, providers can do a lot to boost their collectors’ productivity and results. Insurance Hold Manager (IHM), a key feature of the Artiva Magnify™ solution, is an easy fix designed to address the long IVR navigation and hold times that plague so many A/R operations.

The Artiva Magnify solution determines which payer to call next and uses IHM to automatically navigate payer IVRs and consume the time collectors historically spend waiting on hold. With IHM, the collector completes follow up on claims with the current payer and is then connected to the next payer call that is already in progress with IHM, thereby dramatically reducing time spent navigating IVRs and listening to hold music. All day long, collectors move seamlessly from one call to the next without having to navigate payer IVRs or endure painfully long and unproductive hold times.

This simple EHR complement translates into a significant increase in productivity and can have a dramatic impact on A/R operations.

 

1. Visibility Into Collector Performance

IHM is one of many EHR enhancements that can supercharge your collectors’ productivity. But the health and success of your A/R operation also depend on how well your collectors—including the growing number who work from home—perform in their roles.

 

“Often, a leadership team believes something is being done a certain way, but an analysis of day-to-day operations reveals it’s actually being done another way—and important things are slipping through the cracks.”

Katy Dettman, Plante & Moran, PLLC
Healthcare accounts receivable valuation: Four pitfalls to avoid

 

This is where your A/R transformation begins: knowing precisely how your collectors are using their time, the quality of their interactions with payers/patients, and any procedural errors or missed opportunities that need to be addressed. The process of measuring individual and collective performance has never been easier or more reliable.

Voice and data monitoring
Managers can listen in on calls, listen to recorded calls, and monitor account-related activities to evaluate performance from every angle.

Dashboard displays
Through their individual dashboards, collectors and managers can see the same steady stream of performance data on a variety of metrics (accounts worked per payer call, time talking vs. holding, calls made, etc.). Managers have what they need to deliver valuable one-on-one coaching, and collectors can independently self-correct.

Performance alerts
When collectors aren’t maximizing their time or progressing toward daily or monthly goals, managers receive timely notifications so they can intervene early.

Collector rankings
Who are the top performers on the team? Knowing where they rank motivates collectors to challenge themselves and improve their standing. Friendly competition among team members builds cohesion, increases engagement, and naturally drives progress on the front line.

 

GetixHealth needed a better way to manage its global A/R workforce. In one easy step, the company improved claim follow-up efficiency by 60%. >> Read the success story

 

 

2. A Performance Management Program That Drives Results

 

“If we expect performance improvement, then we must constantly measure and then actively move. Effective revenue cycle reporting should be developed not only to monitor our current success, but to manage it to the next level.”

Luanne Yeley, Halley Consulting Group

 

Regular, intentional coaching and training is essential for driving performance gains and keeping collectors engaged. With a steady stream of data, a more efficient and relevant QA process, and the benefit of timely alerts, managers can provide specific, actionable feedback that helps collectors make meaningful improvements and reaffirms their value to the organization.

Automated QA tasks
Call recordings are automatically matched with account records, and performance data is fed directly into collectors’ QA scorecards. Free from having to manually pull and evaluate random payer calls—which may not be representative of a collector’s overall performance—managers can use their time to coach and train as needed.

More relevant scorecards
Arbitrary or subjective definitions of “quality” might not reflect what collectors should focus on to get the best possible results. A QA scorecard that’s shaped by performance data is a more relevant and useful measure.

Better team management
As they watch performance data and QA scores change in real time, managers can identify widespread problems and provide refresher training. They can also share information with other internal teams to improve RCM overall.

Bigger performance gains
With more meaningful QA scoring and timelier intervention by managers, collectors can set goals, understand how they’re progressing, and continue to improve their scores, rankings, and recovery rates.

 

3. Tools That Boost Agent Productivity

Ample performance data and timely, valuable feedback help keep collectors sharp and motivated. But collectors also need help juggling high account volumes and making the most of every call. The right tools and resources can eliminate a lot of wasted time on the phone and ensure nothing gets missed.

Work queue scheduling
Collectors always know in advance which accounts they should prioritize. Collectors can be scheduled to move between queues based on time of day or duration so they can work accounts more evenly.

Insurance Hold Manager
We discussed Insurance Hold Manager (IHM) in our previous RCM Reality Check post. By drastically reducing IVR navigation and hold times—which can consume a third of the average collector’s workday—IHM alone can significantly increase productivity.

Agent Playbook
Process guide helps new collectors perform on a par with their more seasoned counterparts. Each time a payer picks up, collectors can refer to dynamic content on their dashboards related to SOP, relevant training, and state regulations governing payer responsibilities.

Look-ahead functionality
No more missed opportunities on the phone: from one call to the next, dashboard displays show collectors which high-priority claims they need to discuss.

 

Building an Accountable A/R Team Is Easier Than You Think

Filling the “EHR platform gap” with these missing capabilities might seem complicated and costly. In fact, the opposite is true. You can have it all, without disruptive change—and, in the process, get far more out of your EHR investment.

Want to know how to transform your A/R operation while preserving existing functionality and workflows? You’ll find all the details in our complimentary eBook “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix.” Download your free copy today.

 

Don’t miss the other posts in this series:

 

Want more insights and tips you can use to improve your financial health? Subscribe to the OS blog, and we’ll deliver them straight to your inbox.

 

Boost Your A/R Results—and Your Business Results—with Ease

In this brief guide, “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix,” learn about the two big revenue drains every provider must address and how to fill your “EHR platform gap” so you can build an accountable collections team.

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

The Most Talked-about Challenges at HFMA Annual Conference

The Most Talked-about Challenges at HFMA Annual Conference

The HFMA Annual Conference in Orlando just wrapped up. Thousands of people came to participate in learning sessions and to talk about issues they face on a day-to-day basis. After talking to many people, the general concerns I heard most were how do providers survive the growing uninsured population, substantial cuts in reimbursements that exist, and potential cuts being proposed by federal budgets?

These fears often had a common underlying question: “How I can control my costs to manage my margin?”

From these discussions, a couple of central themes presented themselves that providers wanted to hear about.

M&A Activity is Still Robust

Mergers and acquisitions continue to be prevalent in the industry, and although they have leveled off somewhat over the last couple of years, they are still happening at a good rate. When two different entities merge, one main goal is the consolidation of resources to become more efficient and lower costs. The whole reason two companies merge is to provide better care to the patient and to help reduce costs so more money can be spent on free care. This is how a merger or acquisition gets approved by regulators.

The big hurdle when this happens is how do you combine separate resources that are on different databases into one integrated solution so that one team can work off it. Options are to pay to integrate the two into a new EHR or combine them into one platform they already have. However, this costs millions and the disruption it can create could make things worse for a while.

The next logical solution is to find software that can do this for you – something that is more cost-effective and can provide better service for a single CBO. Providers want to know how they can accomplish this.

Doing More with Less

With reimbursements going down, a lot of talk took place about how they can do more with less. Labor is the biggest budget item any provider or business faces, so with revenue shrinking, providers need to get more productivity out of their staff. Providers were very interested in learning how technology can help them get more out of their existing staff.

Simple things like “how many claims does a rep work when talking to an insurance payer” were questions that providers could rarely answer. Having a solution like Artiva Magnify that can track what an agent is doing in real-time along with historical performance data is key to getting this accomplished, and providers wanted to hear about it.

Providers are clearly thinking about the future and how can they control costs to maintain margins. Possible changes in federal reimbursement models are making them even more concerned. How to combine staffing centers into one manageable database and managing agent productivity were central discussion topics to help control and/or lower cost.\

The technology exists, so there are options. Keep on looking, as these will be critical factors to managing a revenue cycle in the future.

Boost Your A/R Results - and Your Results - with Ease

In this brief guide, The Accountable Collector: Transforming Healthcare A/R with One Simple Fix, learn about the two big revenue drains every provider must address, and how to fill your “EHR platform gap” so you can start building an accountable collections team.

5 Disruptions Healthcare Providers Should Prepare to Address in 2019

5 Disruptions Healthcare Providers Should Prepare to Address in 2019

2018 was an interesting year across the healthcare landscape. We saw strong attempts to dismantle the ACA, the dawn of the healthcare digital age with personal devices, continued strong growth by private equity investment firms and huge mergers along with disruptive market entries by an Amazon led coalition. The healthcare industry, routinely viewed as the slowest to adopt new technological advances and implement innovative ideas, is being faced with new disruptive forces — forces that won’t wait for the industry to catch up. So what does this mean for healthcare providers and what can they do to prepare for 2019?  Here are five predictions to consider:

  • Rising labor costs will drive innovation with providers – Slow rises in reimbursements from commercial and federal payers, combined with a lower commercial payer mix from an aging population, will cause tremendous margin pressure for providers. This will force them to find a way to either improve their cost to collect and/or find an outsource model that makes sense. More forward-thinking providers will look to improve their operations with RPA functions and find ways to adapt machine learning into their processes. Others will look for help from vendor partners/outsourcers to bridge that gap. Either way, finding a way to bridge the gap will be critical to maintain margin. 
  • The Amazon lead coalition will make a statement in 2019 – If we think for one minute that Amazon, who has been a huge disruptor in every market they have ever entered, will not do the same thing with healthcare in 2019, we are kidding ourselves. What will that be? Some say it could be their own insurance plan or maybe a way to break into the drug market.  While we don’t know the answer for sure just yet, we do know they will likely take a first step in 2019 to address the industry’s concerns to help drive down healthcare cost.
  • The Amazon coalition disruption will fuel even more investment by PE firms and lead to more mergers/acquisitions in 2019 – The investment by PE firms has continued its growth trajectory for the last few years and predictions are this will continue in 2019. We will also continue to see more mega-mergers like CVS and Aetna because of this movement.  The issue of growing healthcare cost is not correcting itself and it’s clear that our government cannot do this either, so the private sector will continue its efforts to find ways to make this change themselves. 
  • The ACA will survive but through a different delivery structure – The federal law as we know it has been stripped of much of its strength. Since a Republican-controlled Congress could not repeal and replace the law, the states have stepped in with newly given authority from the Federal Government to make changes. What does this mean? Republican states will continue to drive work requirements on Medicaid patients and push non-compliant exchange plans. Democratic states will work to expand Medicaid, strengthen the existing exchange plan structure and create their own mandates. The future of the ACA will most likely come down to the Presidential election in 2020, but until then we will see rulemaking falling to the states, creating different standards for each.
  • Growth of telemedicine and low-cost delivery models leading to specialty companies – HDHPs are still rising and the amount being pushed to the patient continues to grow. This has led to the growth of specialty companies looking to take market share from providers for these services.  Telemedicine companies exploded, retail clinic partnerships expanded, and the creation of in-house medical treatment options for larger companies and direct relationships with providers – both of which cut out the payer – grew in 2018. Unless the health system is a part of the venture, they lose this revenue stream, as traditional doctor’s office visits are no longer needed. It also presents problems as it can take away a valuable referral path for providers to maintain traditional procedures that make up the lion’s share of their profitable revenue. This has grown exponentially over the last few years and is expected to continue in 2019.      

This past year has been an exciting one with new entrants into the market that appear poised to make disruptive changes in the industry.  Exciting as that may be, let’s be clear — As our nation’s spending on healthcare continues to grow faster than inflation, we are at a crossroads. Time is running out and change must happen soon.  It does not appear that traditional avenues will work, so these new entrants and initiatives in the market are timely. Technology and innovation will be interesting factors for healthcare in the years to come, but 2019 could be the year where healthcare takes that next big step forward. Either way, the face of healthcare is rapidly changing, and it will be exciting to see where it goes next.

 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2019 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Healthcare Revenue Cycle – A Changing Environment

With change on the horizon affecting profitability, it is more critical than ever to look at ways to improve your revenue cycle process. Tackling the whole process at once can be overwhelming. Here are four areas where you should focus.

3 Opportunities to Align the Hospital and Practice with RCM Functions

3 Opportunities to Align the Hospital and Practice with RCM Functions

While healthcare providers continue to feel stress from reduced reimbursements and lowering margins, those issues can be conquered largely through the effective collection and use of data, along with good old-fashioned communication. That’s the conclusion from a panel on which I spoke recently at the Becker’s 4th Annual Health IT + Revenue Cycle Conference, Sept. 21 in Chicago.

Ayla Ellison, managing editor of Becker’s Hospital Review, moderated the discussion “Aligning the Hospital and Practice with RCM Functions,” which included panelists Donna Royster, MHA, PMP, administrative director of radiation oncology at Levine Cancer Institute, and Sherri Peavy, MBA, BSN, RN, chief operations officer at Mile Square Health Center, University of Illinois Hospital & Health Sciences System.

Collectively, we identified three opportunities for gaining and improving alignment across the provider’s RCM process.

 

Opportunity 1: Understand the importance of managing denials across departments

Denials continue to be a source of stress for providers. The keys to managing them are:

  • Get good data through rolling up denial higher-level categories into subcategories.
  • Share the data back to all areas of the revenue cycle, such as registration and coding, for example.
  • Work on a couple of denial categories each month at a payer level to continue gaining traction.

 

Opportunity 2: Use agent productivity as a key performance indicator

We all have solid KPIs for the revenue cycle process, but one that is gaining more momentum is agent productivity. The ability to track activity at a more granular level is critical. Understanding whether a rep actually worked an account versus just looking at it is key. You also determine the need to understand how much time an agent spends in between accounts or away from his or her desk.

The ability to track this data and manage the time that valuable resources are spending on accounts will be key as reimbursements continue to get cut. Providers must find ways to do more with less; thus, managing agent productivity becomes imperative

 

Opportunity 3: Build effective communication practices across functional areas

We often see silos in the revenue cycle process from the front end to the back. For example, registration and coding report to different leaders than billing and collections. As you identify an issue, it is important to communicate across all the functional areas, perhaps in an ongoing monthly cross-functional meeting.

When you do meet with those other areas, be sure to connect the impact to its dollar value. Talking about 500 accounts that have an issue is not as impactful as saying, “This issue impacts $2.5 million in receivables.” Correlating the impact into hard dollars helps underscore the importance of an issue.

By combining technology and communication, and tying them back to the organization’s business strategy, each of these opportunities holds the promise of delivering significant positive change to the provider’s business.

 

Take Charge of Your Revenue Cycle—and Your Future

Healthcare providers are under intense financial pressure from all sides. Amid growing uncertainty and unease, revenue cycle optimization is now priority #1. Learn how you can improve RCM through increased productivity and cash recovery.

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Call Insurance Companies the Right Way, and Find Your Productivity Improvement Silver Bullet

Call Insurance Companies the Right Way, and Find Your Productivity Improvement Silver Bullet

Need evidence of healthcare’s continuing financial challenges? Recently, Moody’s announced not-for-profit hospital margins are at a 10-year low. Congress continues to look at more budget cuts in federal reimbursements. The ACA continues to lose members, pushing people back to the uninsured ranks. This does not paint an inspiring revenue picture in the immediate future, and organizations are looking at how to do more with less.

Knowing how to deal with insurance hold times is an important factor in pursuit of better productivity. When you consider any revenue cycle process, calling insurance companies to get the status of a claim is clearly a large labor-intensive function. And any analysis of a business’s budget will show labor is the biggest expense line item. Healthcare is no different. Reducing the amount of time your reps spend on hold with insurance companies is a tactic to improve bottom line results.

How much would it help, realistically? Horror stories of 60-minute wait times for a payer rep to answer are common – But those are the outliers. According to our analysis of thousands of calls and a multitude of payers, it takes eight minutes, on average, to navigate the IVR, and wait on hold to get a payer rep on the line.

Eight minutes may not seem like a ton of time, but when you consider the number of calls one of your agents can make in a typical day, the amount of time wasted just to talk with a payer rep is significant. Do the math: Check your agent’s daily stats and look at the number of accounts they work in a day. Take that average number of accounts and multiply by eight minutes. You will likely see as much as a third of their time spent waiting for the payer rep to pick up.

Think about that: A third of your most expensive resource is taken up by time spent waiting for a payer rep to answer. In an age of automation and AI, bearing this issue isn’t a necessary path to raise productivity. Adopting innovative tactics can significantly reduce the time your reps spend on hold and navigating IVR.

Let’s look at some ways you can cut down on this wasted time:

  • Use payer data to determine when you should call – Basic data like how long on average it takes a payer to respond to a claim should be easy data you can capture and use. If it takes a payer 21 days to issue their first response, then why waste resources calling the payer? There are other tools you can use instead.
  • Stop calling – In the first 2-3 weeks after a claim is filed, it is a better idea to use an AI tool to check the status of the claim from the payer website. This is not standard EDI transactions but AI that can review a website for the data you need. This technology exists today – use it instead of calling and/or checking the website manually.
  • Use concurrent calling when calling a payer – When you do have to make a call to the payer, use concurrent calling to reduce the time your agent has to wait on hold. If you know the average talk time is eight minutes and your average hold time is 8 minutes then time a second call to the payer so that the call is ready soon after you hang up on the first call.
  • Look ahead while on the call with the payer rep – Work as many claims as possible when you get on the phone with the payer. It may seem obvious, but make sure you sort claims by the biggest value and the correct payer. Are each of those claims open in tabs on the agent’s screen so navigating between each is as simple as one click? Will the recording be properly concatenated on each claim? These productivity tools each make the process faster and more efficient.

For a long time, we’ve all known calling payers was very inefficient, and a waste of a valuable resource’s time. Quantifying this wasted effort is a good way to see just how much opportunity you have. Technology has always been slow coming to the healthcare revenue cycle, but now it has arrived. Look at some of these tasks and see how you can make your agents more productive in these challenging financial times.

Download this ebook to learn how you can boost productivity and recover more revenue.

 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2018 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

What Were the Big Topics Shaping HFMA’s Conversation This Year?

What Were the Big Topics Shaping HFMA’s Conversation This Year?

 

At HFMA’s Annual Conference this year, tech-enabled productivity enhancement was the big solution on everyone’s mind when it came to healthcare’s biggest challenges. Providers are certainly facing real financial issues at the moment, with a balancing act driven by a multitude of factors. Here are the big ones buzzing on the event’s floor this year:

  • Those shaping federal policy continue to chip away at the Affordable Care Act (ACA), and those at HFMA this year kept asking the same question – “What happens next?” Specifically, how much revenue will be lost as fewer patients maintain insurance coverage? Are we moving back to the pre-ACA days where financial assistance at pre-reg and reg took on outsized importance? When will we know?
  • We heard many discussing patient engagement and satisfaction once again, with a recent InstaMed study highlighting how healthcare ‘customers’ are demanding a different experience that providers still can’t meet. Many were asking the same question – “How do we do more with less?”
  • Employees focused on healthcare revenue cycle need to be met on their terms, especially as companies like Google, Indeed and others have modified their work environments for a new generation. It’s time for providers to look at similar changes.
  • While healthcare organizations can spend hundreds of millions of dollars on backbone technology like Epic, certain needs still aren’t being met. Many at HFMA were asking how to meet them with specialized software for point solutions, add-ons for unique functions and more. The question this year was where to find it.
  • Will we see cuts in federal reimbursement yet again?
  • Where have the breakthroughs been in making the revenue cycle more efficient? Many spoke at this year’s conference about agent productivity, and how to help staff more easily navigate the complexity of their daily work. Providers need better accountability data and workflow analysis to make better decisions about their processes, and tie their agents’ data to financial performance.
  • How will telemedicine’s growth impact the provider’s volume of traditional office visits?
  • Are AI and machine learning on a precipice now that data aggregation has become a top-of-mind concern? Many health systems have learned to efficiently bridge multiple legacy platforms to accommodate continued M&A activity – That kind of consolidation means the revenue cycle has become more integrated than ever, and it can only drive unexpected and exciting evolution.

These topics have, and will continue to shape healthcare’s financial outlook in the coming years. That much is clear. And at a time when it feels like many conference events are waning, it’s inspiring to see how HFMA remains well-attended and vibrant. It’s an event that reflects an industry and discipline in constant evolution, if not revolution, and that’s why we’ve kept our eyes peeled and ears open as new practices and technology have brought important changes to medicine, and a U.S. population that’s well-cared-for. We’re looking forward to what the remainder of 2018 will bring, as we step over the horizon into a new healthcare environment that services patients and communities better than it has ever before.

 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2018 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Discover the Productivity Edge You Need at HFMA’s Annual Conference Next Week

Discover the Productivity Edge You Need at HFMA’s Annual Conference Next Week

 

Over the past 10 years, patients have seen a steady rise in their out-of-pocket healthcare expenses. Not shockingly, a key contributor to this increase is the popularity of high-deductible health plans, toward which employers are gravitating in order to control their organizations’ costs.

A recent Kaiser Family Foundation/HRET survey of Employer-Sponsored Health Benefits reports the average out-of-pocket expense for a patient has risen a staggering 130% since 2008. This financial responsibility has fallen to patients—many of whom have mortgages, auto loans, utility bills, student loans and more— and providers are finding themselves at the bottom of the priority list when it comes to settling accounts.

Futhermore, this year’s HIMSS study, “Health Systems’ Revenue Cycle Management and Challenges,” shows more than 1 out of every 4 providers surveyed find performance tracking to be the toughest data to collect. This study and Kaiser’s underscore why productivity enhancements have become truly top-of-mind for healthcare’s financial leaders.

Providers find themselves in a predicament:

  • Unexpected expenses, like emergency room bills have become impossible for many to pay
  • Revenue shortfalls are on the horizon, especially as Medicaid funding/eligibility tighten
  • New accounting standards in bad debt reporting from the IRS challenges 501(c)(3) statuses

Better productivity is the solution. And HFMA’s Annual Conference is where the most important conversations to find it will happen this year.

If you’re headed to the Conference in Vegas next week, it’s important for you to find the technology that will chart a navigable, efficient course for your organization’s revenue cycle process.

How do you find the best and quickest path to revenue cycle efficiency? Connect with us at HFMA, and let’s talk about your options. Our Artiva HCx software, for example, aggregates disparate data relevant to your business office, and displays only the accounts that need to be worked with exception-based processing to optimize your account reps’ productivity. . It’s like a GPS for their day, mapping out a more productive path for communicating with patients and payers.

As you route your own travels through HFMA this year, make sure to drop a pin on the Ontario Systems booth. We have a large presence at this year’s event, with several of our business and product leaders available on-site to answer any questions you may have. Connect with us to learn more about the productivity advantages our solutions provide for your representatives. And while you’re at it, take a minute to drop a chip in our GPS Your Day game for a chance to win a prize that’ll help you get just a bit more done than you did yesterday.

See you in Vegas!

 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2018 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.