Optimizing Revenue Cycle Management During the Transition to Value-Based Care

December 4, 2018


The rules of reimbursement are gradually changing, but in the healthcare game, no timeout can be called. No wonder those in the field are feeling a little dizzy and disoriented.

Forced to deal with a mixture of fee-for-service and value-based reimbursements, providers feel as if they have “a foot in each canoe,” says Humana Chief Medical Officer Roy Beveridge, MD. “That is a very unstable, uncomfortable position to be in.”

To put it mildly.

It’s a balancing act, and as the landscape continues to shift, providers are dealing with an increased sense of urgency to keep revenue flowing and stay in the game.

Mind the gap

Among the first and most important challenges in this changing world is to bridge the traditional gap between patient-facing front ends of practices and business back-ends.

QueueLogix provides that bridge, with a suite of technology solutions that make revenue cycles faster, stronger and far more efficient:

  • “LiveData” allows users to visualize large amounts of clinical and financial data. Users choose which metrics to track, so every action is rooted in data intelligence. Compelling charts and graphics make it easy to detect discrepancies and errors, fix them quickly, and address recurring problems.
  • “LiveTask” ensures that everyone involved in billing has access to the most up-to-date information. Collaboration among coding personnel, clinical documentation improvement teams, compliance and quality review professionals reduces the time needed to resolve complicated issues, and helps speed up billing.
  • “LiveSentry” uses artificial intelligence to analyze patterns based on customized guidelines, and to identify patient encounters that may require further attention—before billing results in lost reimbursements or denials. Essentially, it predicts mistakes before they can happen.
  • “LiveCode” links coders and scribes in a clinical, real-time environment. From the moment a new patient registers until the time the appointment ends, scribes can chat with coders in real-time. The coder gets needed answers directly through a dashboard, so transactions that once took days, now take seconds. And snags like suspended charts (caused by missing documentation or unclear notes), discharged not final billed (DNFB) cases, non-compliance and days sales outstanding (DSO) can be reduced or virtually eliminated.

New approaches

The shift to value-based reimbursements may also call for a shift in attitudes. Patients aren’t just patients, anymore. In an era of growing consumerism, they’re customers who want and need to be engaged.

Customer satisfaction has become an imperative. So much so that hospitals that treat customer experience as an investment, albeit while incurring increased costs, increase revenue even more, says Deloitte. For example, they make it easier for patients to handle their increasingly large deductibles by offering payment plans. Not only do they improve their chances of eventually getting paid, they also appeal to patients who might otherwise avoid the care they need.

CareThrough’s navigators and ScribeAmerica’s medical scribes also promote customer satisfaction and resultant revenue flow. CareThrough helps build relationships with at-risk patients, encouraging them to schedule appointments and making sure patients follow through with care plans. Meanwhile, scribes lighten the intense burden of administrative tasks for physicians, which in turn increases both the time, and the quality of time, they can spend with patients.

Machine learning

Artificial intelligence provides yet another path to better patient experiences and better outcomes. LifeLink’s chatbots interact with patients in a way that’s both familiar and comfortable—via text message. They’re sophisticated enough to identify a range of questions and prompts, and respond accordingly. Patients are made to feel as if they’re talking to a friend or acquaintance, not a computer.

So, for example, a patient arriving at the ER can receive updates about her wait time, lab results and other useful information. Meanwhile, chatbots deliver “real-world” data gathered through patient conversations to EMRs, creating an expanding loop that can lead to improved diagnoses and outcomes, as well as greater satisfaction.

Steady ground

The rules are changing and the footing sometimes feels treacherous, but with the right tools, techniques and attitudes, revenue streams can be made to keep flowing smoothly, helping to facilitate the transition to value-based reimbursements.