Huron Healthcare Identifies Five Revenue Cycle Priorities For The New Healthcare Environment

Huron Healthcare recently released a briefing detailing five proven strategies that can help hospitals and health systems optimize revenue cycle management in the new era of risk-based payment models and greater self-pay by patients.

“These approaches adjust priorities for the new payment models and enable providers to leverage the revenue cycle to unlock additional value, which in turn can significantly improve their financial wherewithal to respond to the challenges and opportunities of healthcare reform,” said Ryan Gibson, Huron Healthcare, managing director.

For high-performance revenue cycle management, providers should:

1. Maximize 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.
2. Address 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
   • Coordinating with physician offices
3. Improve 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 robust 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.
4. Bolster 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.
5. 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.

“It is important that organizations have the infrastructure in place to measure and monitor results of leading indicators across the revenue cycle,” said Paul Johnson, managing director, Huron Healthcare. “These five strategies can help revenue cycle leaders add value to their organizations by preparing them to meet the challenges and opportunities of today's healthcare environment.”

About Huron Healthcare
Huron Healthcare is the premier provider of performance improvement and clinical transformation solutions for hospitals and health systems. By partnering with clients, Huron delivers solutions that improve quality, increase revenue, reduce expenses, and enhance physician, patient, and employee satisfaction across the healthcare enterprise. Clients include leading national and regional integrated healthcare systems, academic medical centers, community hospitals and physician practices. Modern Healthcare ranked Huron Healthcare third on its 2013 list of the largest healthcare management consulting firms. For more information, visit www.huronconsultinggroup.com/healthcare.

About Huron Consulting Group
Huron Consulting Group helps clients in diverse industries improve performance, transform the enterprise, reduce costs, leverage technology, process and review large amounts of complex data, address regulatory changes, recover from distress and stimulate growth. Our professionals employ their expertise in finance, operations, strategy and technology to provide our clients with specialized analyses and customized advice and solutions that are tailored to address each client's particular challenges and opportunities to deliver sustainable and measurable results. The Company provides consulting services to a wide variety of both financially sound and distressed organizations, including healthcare organizations, leading academic institutions, Fortune 500 companies, governmental entities and law firms. Huron has worked with more than 425 health systems, hospitals, and academic medical centers; more than 400 corporate general counsel; and more than 350 universities and research institutions. For more information, visit www.huronconsultinggroup.com.