Revenue Cycle Management
Healthcare Blog

Revenue Cycle Management Teams continue to stare down a monstrous business agenda. System conversions (pre and post), new business platforms (like ICD-10), acquisitions, consolidations, navigating the Affordable Care Act, and compression (shrinking revenues coupled with increased expenses) are just some of the difficult and complex jobs that make up most provider’s ‘to do’ list. No deus ex machina, no silver bullets, and no superheroes to save the day – winning will simply require a lot of calculated (tough) decisions and a lot of hard work.

As it is with sporting events and political campaigns, intangibles and soft skills will play a big role in determining whether leaders and managers within Provider organizations win. So looking at the keys to success for Revenue Cycle Management Teams – and in the category of intangibles and soft skills -- I see three elements that are musts:

1. Leadership
2. Change
3. Change Management

It seems as if there is always something changing within the healthcare field these days. Denial Management (or as a nice woman told me she likes to call it, “Denial Prevention”) is no different, and has its own struggles in this ever changing field. A lot has changed, and will continue to do so as we try to optimize how we process denials.

The way your facility handles denials is very important for reimbursement. Duh, right? It used to be that someone in this department (or at least someone who knew the job) would get a letter from the insurance company stating why it was denied. After that, the appeals process would begin. This tied up funds or reimbursements for quite some time and would involve the investment of copying an entire chart and having physician advisors review that chart. This process is very costly and time consuming. Medicare has decided to hold facilities accountable for what they do.

Before I started making sales pitches to CFOs, Directors, and VPs on why I think they should make VARO Healthcare an extension of their business office, I was making sales pitches to regular people (all jobs aside) - in their homes. And guess what I was selling? I was selling cemetery plots. Yep. But, it was BEFORE death. Awkward. Cold-calling daily and making appointments with people in their homes to convince them to pre-plan their funeral expenses. I’d go through an entire presentation all the while trying to evoke some sort of emotion about how much better it is to pre-plan rather than put your family through the hassle of dealing with it after they die. Weird, I know. It’s difficult to persuade people to believe in what you’re selling, even though YOU believe in it, “yes, you should spend XYZ now to pre-plan so your family won’t have to later”.

As parts of the Patient Protection and Affordable Care Act begin to roll out, it's important for healthcare providers to understand that healthcare in the United States is becoming increasingly driven by performance. I've said this before in previous blog posts, but it's something that needs to be overstated. Although giving out both incentives and penalties for the quality of care that institutions provide is still a relatively new cost model; this is our future and healthcare organizations must be prepared for this new reality - which I'm sure most of you reading this agree you already are (at least, I hope!). How exactly will healthcare organizations be able to estimate the cost of care based on the value they deliver versus the quantity they provide? This is one of the most pressing questions boggling the minds of many healthcare executives, particularly those who work in the finance and accounting departments of these organizations.

In my last blog Revenue Cycle Management, Way Downstream I said employee scorecards are a great tool to use within a revenue cycle management strategy. I wrote this blog to pass along tips and techniques for setting up and administering employee scorecards. Click here to download a sample Employee Scrorecard template. 

One of the biggest legal changes to the United States health care system that will have a major impact on healthcare providers is the Federal Government’s new Hospital Value-Based Purchasing Program. Regardless if you are the manager at a large hospital system, an administrator at a smaller outpatient treatment facility or a doctor that treats Medicare patients; it is important to understand that the government wants to pay medical providers according to health outcomes of patients. This change presents a huge shift in current US healthcare policy where providers were traditionally paid for their services - regardless of patient health outcomes. This new hospital-based pay-for-performance system officially began in October 2012 and will be one of Medicare’s largest improvement campaigns.

So, I figured I should write about RACs because they seem to be the topic of conversation at most HFMA events I attend. I am NOT an expert on this particular subject, but with research and talking to people within the industry, I found some interesting tips. A survey I read released by the American Hospital Association mentioned the requests for medical records from Medicare’s wide-sweeping Recovery Auditory Contractor (RAC) program are up over 47 percent since 2012. Therefore, there are some important things that your healthcare organization should consider when looking to reduce your RAC financial risk.

Two of the companies within my organization -- VARO Healthcare and BYL Collection Services -- service patient pay accounts receivable and patient pay bad debt.

Back in June I wrote a blog about the challenges of managing legal risk in the consumer contact business.

Crazy times in the world of revenue cycle management. Based on everything you see, hear, and read: revenue cycle management teams have their hands full with a ‘to do’ list that runs the gamut on areas of concern – system conversions, new systems, new processes, new laws, new regulations, new financials, change management, and a ton of uncertainty.  How to prioritize the work, how to parse out the work, and how to execute change has a lot of Revenue Cycle Management teams really stressed out.