February 27, 2018
Five Ways to Improve Revenue Cycle Management in 2018

Used to be that when it came to compensation, healthcare providers could rest pretty easy, knowing they could count on payers — private and public — to provide the overwhelming majority of their revenue. Sure, there were the usual coding and billing challenges, and the wrestling matches over denials, but patients were mostly spectators when it came to financial transactions.

Not anymore. As high-deductible plans become more and more prevalent, providers are finding it increasingly difficult to collect what they’ve earned.

Plans that force consumers to dig deeper and deeper into their own pockets have skyrocketed in the last few years, notes Doug Vanderslice, chief financial officer and senior vice president at Boston Children’s Hospital. Consider: In fiscal 2016, Boston Children’s Hospital reported $65.2 million in unpaid collectibles. That number was 68% higher than the previous year’s, and a full 100% increase from 2012.

It’s not an isolated problem. According to TransUnion Healthcare, 68% of patients with bills of $500 or less didn’t pay off their full balances during 2016. That’s up from 53% in 2015 and 49% in 2014. Worse yet, TransUnion projects that by 2020, 95% of patients won’t pay their bills in full.

It’s an unsustainable trend for hospitals and other providers. But the ever-increasing number of high-deductible plans shows no signs of abating.

New criteria

And that’s not the only revenue-management issue facing providers. The mandated shift from fee-for-service to value-based reimbursement models continues to gain steam, and with it a shifting landscape in which providers increasingly will be paid based on quality metrics and patient outcomes, regardless of the volume of care they provide.

The need to eliminate costly unnecessary care will in turn place a premium on practice management, efficiency and communication between patients and providers.

Five tips

As new challenges continue to mount, how can providers large and small improve revenue cycle management? Experts suggest several areas to focus on:

  • Make it as easy as possible for patients to pay. First, make expectations clear from the get-go. If possible, consider contacting patients before appointments or procedures to confirm how much they’ll owe and when they’ll be expected to pay. You may even be able to take payments over the phone. How about keeping patients’ credit cards on file? A Navicure survey found that 78% of patients are comfortable with the idea, but only 20% of providers offer such an option. For patients who find it extremely difficult to pay their entire bills upfront, try to work out payment plans and financing options, suggests Bird Blitch, chair of the Healthcare Information and Management Systems Society (HIMSS) Revenue Cycle Improvement Task Force. A little bit at a time is a lot better than nothing at all. An online payment portal is yet another option.
  • Eliminate front- and back-end silos. When the patient-facing front-end staff and the back-end coding and billing staff are completely segmented, knowledge gaps are perpetuated and claim processing becomes less efficient, says Rebecca Wright, chief operating officer at Illinois’ Iroquois Memorial Hospital. Her hospital, she says, increased point-of-service patient collections by 300% by, among other things, having billers, centralized schedulers, and registration staff teach their colleagues about their jobs. For example, registration staff learned how important it was to understand eligibility and select the right insurance company before entering it into the system, since mistakes were bound to result in denials and long delays.
  • Track key performance indicators. Sandra Wolfskill, director of healthcare finance policy and revenue cycle MAP at the Healthcare Financial Management Association, recommends tracking net days in accounts receivable, cash collection as a percentage of net patient services revenue, claim denial rate, final denial write-off as a percentage of net patient service revenue, and cost to collect. Those indicators reveal whether staff are accurately and efficiently performing their assigned tasks, she says, and let you “see very quickly if the trend line is going in the right direction.” If things are going in the wrong direction, she adds, consider how to better manage your workforce and resources.
  • Automate prior authorizations and eligibility. Providers are facing more and more demands for prior authorizations, according to a Medical Group Management Association survey: 86% said requirements increased in 2017, while only 3% said they’d decreased. Along with being a hassle, they can be an unnecessary expense. But electronic authorizations reduce the time per transaction from 20 minutes to 6, and the cost from $7.50 to $1.89, says the Council for Affordable Quality Healthcare.
  • Have a dedicated care coordinator. A care coordinator can help manage the transition to value-based reimbursements by keeping up to date with legislation and policy changes, serving as a liaison between patients and providers, encouraging patients to be compliant and responsible, and by organizing health and wellness clinics. Those efforts can lead to better health outcomes and higher reimbursements.

Help is available

In today’s increasingly challenging environment, a company like QueueLogix can reduce the revenue-management burden on providers by connecting back-office coding and frontline patient encounters, expediting billing times, increasing compliance and improving revenue cycles. With advanced software that uses artificial intelligence and rules-based logic, QueueLogix focuses on the inter-related business processes among coders, billers and physicians.

The company offers a software-as-a-service licensing model for providers who already have coding, billing and other personnel in-house, and a bundled software-and-services package for hospitals, healthcare systems, private practices and emergency departments that would like to increase productivity and profitability by also relying on their highly skilled specialists.

Care Navigators
As healthcare business models evolve, so should care teams.

Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.

Chronic Care Management
With an increased aging population managing two or more chronic illnesses, extending your care teams’ ability to communicate with patients is critical. We take a strategic approach to helping patients chart a path towards their health goals, while self-managing their chronic conditions between clinical visits.

AI Chatbots
We deliver a robust AI Chatbot solution to help manage and sustain effective communication with patients. Care teams implement the conversational text messages and customize patient communication to deliver high quality care.

Nurse Care Team Assistants
While nurses comprise the largest healthcare workforce, many suffer in silence from burnout and decreased job satisfaction. Our Nurse CTAs combat burnout with strategic support. From documenting patient encounters to monitoring vital signs, CTAs ensure nurses work top-of-license. CTAs close critical gaps in the care continuum and provide nurses with the added bandwidth to focus on critical care.

Point of Service Collections
Our Point of Service Collections program offers an innovative approach to payment collections. Utilizing Care Team Assistants at the point of care layered EMR agnostic technology, patients have better insight and clarity into their payment options and EDs drastically improve their revenue collections without costly IT implementations

Referral Management
Referrals scheduled by navigators in the clinical setting builds long term, patient care integrity across the care continuum. With the authority, along with the provider to search for specialists in network, navigators assess their schedules, and ensure appointment compliance.

Scribe Services
There’s a reason why we’re the nation’s most frequently used scribe company: we offer professionally trained medical scribes to meet the specific needs of our clients. We offer a variety of scribe programs, as well as technology and personnel solutions that address revenue cycle management, the transition to value-based care, and more through our HealthChannels family of companies.