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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.

 

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.

Posted by Shawn Yates

Shawn Yates serves as Director of Product Management for Ontario Systems, defining the company’s strategy for product and service offerings in the healthcare market. With over 20 years of experience managing self-pay receivables and collection operations for a top 20 healthcare system, Shawn’s background also includes working for a national outsourcing company helping clients manage their insurance and self-pay receivables, and Experian Health, the largest data and analytics company in the country.
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