Revenue Cycle Priorities For The New Healthcare Environment

By Christine Kern, contributing writer

Huron HealthCare Offers Times for RCM Priorities

By Christine Kern, contributing writer

As market pressures and payer shifts create new challenges for healthcare organizations, emphasis on revenue cycle management becomes increasingly important. To help organizations respond proactively, Huron Healthcare managing directors Ryan Gibson and Paul Johnson have identified five strategies to optimize revenue cycle functions. Their analysis, "Priorities for Revenue Cycle Reform," appeared in the February 2014 issue of Revenue Cycle Strategist.

“It is important that organizations have the infrastructure in place to measure and monitor results of leading indicators across the revenue cycle,” says Johnson. He and Gibson suggest focusing on the following areas:

• Maximizing Collectability Under New Reimbursement Models
  With reimbursement increasingly tied to quality of care, providers need to develop better capabilities for measuring how clinical outcomes will impact reimbursement for each payment model. To do so, they should make use of real-time monitoring of key performance indicators. Strengthening collaboration between departments such as contracting and quality and with physician offices can more tightly link quality and outcomes, minimize denials and improve reimbursement.
   
• Addressing Increases in Patient Liability
  By leveraging predictive analytics, some organizations have been able to increase patient-owed collections by 10 to 20 percent. Other strategies should include: expanding upfront payment programs, communicating a patient’s liability as soon as possible, proactively managing self-pay account and balance-after-insurance liabilities, and coordinating with physician offices.
   
• Improving Clinical Documentation
  Maximizing reimbursement under value-based payment models requires keeping precise clinical records. It entails accurately capturing presenting conditions, severity of illness, and the full spectrum of care provided. A clinical documentation improvement program can help ensure that organizations accurately represent the acuity and complexity of care delivered, as well as support more accurate reporting specific to case mix index, present-on admission, healthcare-acquired conditions, core measures, and physician and hospital profiles.
   
• Bolstering Defensible Service Pricing
  In an increasingly transparent environment, healthcare organizations must be prepared to defend the rationale behind the charge for each and every service provided. At the same time, many hospitals and health systems are currently challenged to enhance net revenue because most, if not all, services are paid at fixed rates by the insurance companies and therefore not subject to prices. In these cases, the organization’s strategy can shift to focus on price rationality at the line-item level in the chargemaster. Organizations should study their specific insurance contracts, as well as their markets, and adjust targeted prices in the chargemaster to a more reasonable price while not creating a negative revenue impact.
   
• Enhance the Patient Experience
  Revenue cycle functions often represent the first and last interactions that patients have with a health system. Creating a seamless and stress-free experience for patients during scheduling and registration helps set a positive tone. In addition, following care delivery, a seamless billing process can help prevent payment confusion. These patient-friendly financial processes can positively impact HCAHPS patient satisfaction scores, which Medicare now ties to reimbursement under the value-based purchasing program.