Cycling through improving revenue management

May 22, 2014


Nearly a dozen healthcare IT executives provided HMT with more than 50 best-practice strategies for healthcare organizations to improve revenue cycle management operations.

  • Maintain a key performance metric dashboard, ensure all key leaders have visibility and understand and execute on the actionable items.
  • Consistently audit the front-end process to ensure complete and accurate data is being collected and managed appropriately, including authorization and case management.
  • Charge capture must be monitored, reported, measured to ensure no leaks are occurring.
  • Contract management, management of short pays and expected reimbursement.
  • Timely billing/claims submission is key to maintaining cash flow.

– John Dragovits, Senior Vice President and General Manager, Revenue Cycle, Allscripts Healthcare Solutions Inc., Chicago

  • Ensure that you have eligibility verification capabilities in place, along with the ability to estimate and accept patient payments, in order to proactively manage each patient encounter. This will provide increased transparency in patient financial situations, helping you enforce patient payment policies and ultimately maximize collections.
  • Implement tools to monitor each claim and know at a moment’s notice where each one is in the claim cycle.
  • Leverage key performance indicators to help understand where your organization stands from a financial performance perspective and better monitor goals, helping you and identify key areas for both short-term and long-term improvement.
  • Utilize benchmarking tools to help understand where providers measure up relative to peers in the industry. While one organization may feel successfully within their four walls, it’s imperative to see where others stand for comparison and benchmarking improvements.
  • Only implement tools that adapt to your existing workflow and work seamlessly to integrate with those current processes. While regulatory changes do require electronic solutions to be implemented, search for the right solution for your organization – you don’t have to settle. 

– Jim Riley, President and CEO, Capario, Santa Ana, CA

  • Minimize patient bill surprises. Transparent pricing for patients is more than just posting the average cost of a procedure on your website. Providing an accurate bill estimate during scheduling and at the point of service is an important part of patient satisfaction. It’s crucial that payor contracted rates are included in the bill estimate equation. One MedAssets client takes their bill estimates to the next level for self-pay patients by automatically applying a self-pay discount at the point of service.  
  • Require consistency across facilities and departments. Use your chargemaster reports to compare specific items in various departments and drive consistency. Our largest clients implement a corporate chargemaster strategy that governs all facilities, and activate that strategy with an enterprise charge description master (CDM) solution.
  • Take a good look: Compare your charges to your costs. Link your item master to your chargemaster to get a complete picture of your pricing strategy in action. Analyze your acquisition costs against target markups and actual charges. The comparison should include billable and non-billable items, along with supplies and pharmaceuticals. By automating the process of mapping the item master to the chargemaster, this strategy is simplified and ongoing maintenance of that linkage is supported. If your organization doesn’t have the resources or expertise to sustain this, services are available to review your comparison each month and provide recommended updates.  
  • Take another look: Compare yourself to your peers. Stay competitive in your market by comparing your pricing data to that of your peers. Publicly available data can be a starting point, but the value increases tremendously when your analysis is based upon more current data that includes inpatient and outpatient information, and can be customized to your needs. Set a regular schedule for reviewing your prices and making adjustment as needed. At the least, this exercise should be done annually. Also, create a workflow that accounts for adding new items to the chargemaster and includes approvals for the related codes, pricing and benchmarks for comparison.
  • Align physicians with spend policy. A key strategy in reducing the variable costs per case for procedures – and keeping actual costs in line with published averages – is a collaborative strategy for physician preference items (PPI). By engaging with physicians to identify opportunities for improvement without compromising quality, the supply chain savings can be significant and patients experience a more consistent procedure cost.

– Amy Amick, President, Revenue Cycle Management Segment, MedAssets Inc., Alpharetta, GA

  • Develop a multi-disciplinary user group focused on ensuring areas related to expense and revenue are addressed through singular or integrated systems.
  • Implement policy and procedure to address consistent naming formats and required data elements throughout applications.
  • Develop tools or report sets that will display metrics and data in a way to easily tie back to the P&L and quality initiatives.
  • Create standardization throughout the enterprise, regardless of whether or not systems are integrated or otherwise connected.
  • Develop and implement policy and procedure specific to the EMR, ensuring timely documentation initiation, completion and signature.

– Karen England, Revenue Cycle Consultant, Ingenious Med, Atlanta

  • Streamline processes.
  • Reduce manual intervention.
  • Decision making based on rules.
  • Linking patient accounts together/Master Patient indexing.
  • Provide clinical data to physicians.
  • Secure all PHI and reduce waste.
  • Work to reduce paper in all process.

– Patrick DeAngelo, Vice President, Technology and Process, McKesson Business Performance Services

  • Insist upon industry standards and terminology sets for data normalization and interoperability.
  • Improve the accuracy of cost and accountability for expense at the point of care in the EHR for purposes of collaborative clinician-patient decision making.
  • Make sure that select data from claims and revenue cycle management processes are available in real-time to all stakeholders.

 – Jeffrey Rose, M.D., CMIO, TriZetto Corp., Denver

Regardless of the tools already in place, there are some practices which I feel are always beneficial:

  • Thoroughly analyze your revenue cycle. Because it requires a sprawling process in most large organizations, it’s easy to be unaware of inefficiencies or opportunities for improvement. 
  • Identify and resolve the low-hanging fruit. It might be outdated charge tickets (common in a paper-based charge world), manual rework downstream, or something else – using your analysis to find the biggest bang-for-buck improvement and implementing it is an action you can take right away. 
  • Implement regular, automated performance metrics. Care-to-Claim Lag, Average “Touches” per Claim, Carrying Cost of Inventory, etc. Developing and monitoring a dashboard of the right metrics makes it easy for executives to align process with goals throughout the organization. This also keeps your process analysis fresh. 
  • Set goals for improvement. Choose a key metric (or two) and communicate incremental goals for improvement to the team across the organization. For example, you might charge everyone with reducing care-to-claim lag from 11 days to less than 10. 
  • Raise the bar. The best improvement is continuous. Once you’ve achieved your goals, congratulate everyone on their success and set a new goal on the next horizon. 

– Patrick Campbell, Product Manager, MedAptus Inc., Raleigh, NC

  • Deploy a revenue cycle system that is optimized to minimize the amount of back-end re-work.
  • Ensure that all team members have the reporting necessary for operational decisions.
  • Ensure that the system employs a denial management system that allow for the diagnosis and root cause analysis of all denials.
  • Scaled operational infrastructure that support large service centers.
  • Integrate systems (the revenue cycle system will require at least a minimum of bolt-on systems)

– Robert Magnuson, Principal Advisor, Impact Advisors LLC, Naperville, IL

Key best-practice strategies that IT execs should employ to improve revenue cycle management include utilizing technology to support:

  • [Adopting and implementing] a global standard.
  • Collaborating beyond supply chain to capture benefits of revenue and supply chain integrity.
  • Establishing a clear and standardized revenue integrity program with investment in resources to support the long-term strategy of cost reduction and flexible payment strategies.
  • Enhancing the supply chargemaster for measurement and benchmarking that will support current and future pricing models.
  • Auditing management, and the maintenance of data integrity on an ongoing basis because a once-a-year approach really doesn’t adequately maintain compliance. Non-compliant data results in revenue leakage, financial risk and greater operational expense managing back-end processes and audit.

– Kathy Schwartz, Product Manager, Craneware Inc., Atlanta

  • Revisit charge capture strategies to ensure all net revenue contractually owed to the provider from all payment sources for the services performed understanding that getting to true cost transparency is mission critical under shared savings and population health management.
  • Understand that not all elements of supply chain contracting or pricing are loaded as unique fields. This masks true costs, making it impossible to match cost and charges and thereby difficult to compete with other facilities on a pay per value model. [For example,] the Medication Spend per Beneficiary ratio may be over or under reported.
  • Explore creative, alternative and better ways and more practical methods to tie, at the patient level, cost and actionable quality metrics that do not require full depth of information.
  • Study the intent of linking systems and forming relationships; e.g., CDM plus IMF with EHR/EMR.  Explore from a supply chain management standpoint and consider functional distinctions that allow matching of revenue cycle management elements.
  • Demonstrate urgency and commitment. There is a transformational mandate for revenue cycle and the time for transformation is now.
  • Advocate industry identification and standardization of metrics and agree upon quantifiable outcomes or differences to expect suppliers to modify strategies and expand risk sharing concepts.
  • Exercise care and thought to intelligently construct systems and data elements to allow easy reconciliation of patient, procedure, cost, quality and outcome. The revenue cycle process necessitates consideration from the perspective of payers and suppliers. An integrated outcome is required by all parties to compete and survive in an Affordable Care world.

– Patrick Flaherty, Director, Supply Chain Management, University of Pittsburgh Medical Center (UPMC)

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