Four stickiest revenue cycle issues

Revenue cycle leaders can fall into a trap of merely managing problems that pop up. But the danger with a “fix it” approach is that so many of the challenges in revenue cycle are connected. Are your denials issues related to staff development in registration or billing? If some of your key indicators are not moving in the right direction, then are you sure you are even measuring the right ones?

These are the among the questions that 50 of the nation’s top revenue cycle vice presidents share at the annual HealthLeaders Revenue Cycle Exchange, which will be held March 21-23 in Ponte Vedra, Florida. If you are a hospital or medical group revenue cycle leader looking to share real ideas and solutions with the nation’s best, we invite you to look into whether the Revenue Cycle Exchange is the right event for you. Participation and travel are free for qualified leaders. Click here for an agenda, list of participants and qualifications.

Some issues always rise to the top of the discussions at Revenue Cycle Exchange roundtables, among them:

1. Dial up the intensity on denials
   Managing denials is ever-present in revenue cycle, and leaders are finding that communication is the old reliable skill that patches many gaps. Orlando Health, a $3.8 billion not-for-profit organization serving Central Florida, reduced claims denials to monthly rates as low as 1% and averaging 4% annually by involving key players.
   A denials management team marshalled support from leaders across the seven-hospital enterprise to introduce workflow measures aiding denials prevention. The group also instructed employees how to minimize or avoid errors. Establishing a multidisciplinary task force of executives and clinical staff to identify prevention efforts also proved beneficial.
   The result of these efforts are cleaner claims. "We have many checks and balances for compliance, from our registration all the way through to our billing," says Bridget Walters, corporate director of enterprise patient access.
2. Hidden costs of poor patient financial experience
   The increase of high-deductible plans makes engaging patients crucial. Patients are often confused about their coverage, so proactively educating patients about their financial responsibility can help offset incorrect information and improve collections.
   Concise statements and easy-pay options have also delivered results. And offering online service--with self-service portals and a chat line for questions about estimates, as well as the ability to pay--can prompt payment and improve patient relationships.
   “We used to have separate bills for our hospital side versus our physician side, and recently we put everything on My Health Online, which is our online system,” adds Alex Collins, director of revenue integrity at Piedmont Athens (Georgia) Regional, a 360-bed nonprofit hospital in the Piedmont Healthcare system. “Combining it makes it easier for patients.”
3. Finding and keeping motivated revenue staff
   ​Sustaining a high-functioning operation requires a top-performing team, but the challenge lies in hiring, training, and retaining a staff who can give excellent customer service.  
   “When hiring, we look for customer service skills first, and then teach them the healthcare side of things versus the other way around,” says Jane McKee, executive director of middle revenue cycle and revenue assurance at Piedmont Healthcare, an eight-hospital, not-for-profit health system based in Atlanta.
   Building an accomplished workforce requires ongoing training, monitoring performance, and coaching. Also valuable is soliciting people’s ideas about perfecting the process.
   To encourage creative thinking, Donella Lubelczyk, RN, director of revenue cycle at Manchester, New Hampshire-based Catholic Medical Center, affiliated with GraniteOne Health System, assigns her revenue cycle committee to develop an improvement project each fiscal year.
   “They have a goal and have to present an update monthly, and we hold them accountable,” she says.
4. Target improvement where it matters
   Fine-tuning revenue cycle operations demands discipline and discernment.  Paul Hanna, senior director of revenue cycle operational reporting for Pittsburgh, Pa.-based UPMC, says one department goal is to “reduce the noise” in reporting.
   “I think a lot of health systems measure too many things,” Hanna says, “If you're measuring things that you can’t act on, you may be measuring the wrong things.”
   At UPMC, much of the analysis comes from reporting about operational details that reflect current activity. Various areas of revenue cycle meet regularly on key performance indicators (KPIs) to spot trends. With KPI data, the team can dissect issues with a process improvement tool like Six Sigma.