Five healthcare leaders shared with Becker’s Hospital Review the biggest revenue cycle challenges they face.
Note: Responses have been lightly edited for clarity.
1. Jenni Alvey, CFO of Indianapolis-based IU Health: The biggest challenge is knowing when to really shift the department to be more value-based focused than fee-for-service-focused, and how to balance the two. In addition, as healthcare reimbursement is changing, the rules around getting people and services authorized, ensuring things are medically necessary and ensuring you've done everything you need to for the payer to actually pay for that visit is becoming more difficult. This adds costs to healthcare and puts the patient in the middle.
2. Aaron Eichorn, CFO of University Health System in Shreveport, La.: Both of the hospitals we manage are in Louisiana, which just underwent Medicaid expansion. So we've had hundreds of thousands of people that were previously uninsured now on Medicaid. It's the challenge of enrolling them, it's the challenge of getting pre-authorizations, avoiding denials and managing the utilization of those patients. All these people suddenly have access to care, and we've got to make sure we can get them in and treat them effectively and get paid.
3. Mark Norby, revenue cycle chair at Rochester, Minn.-based Mayo Clinic: Revenue cycle leaders and their teams face many challenges, such as reimbursement and regulatory changes or technology gaps in patient accounting systems. A significant operational challenge is the increasing demand for pre-certification and prior authorization required by private or government payers. The process is manual and time consuming but necessary. The process needs to be reviewed collaboratively between payers and providers.
4. Brian Unell, vice president of revenue cycle at Piedmont Healthcare: Our biggest challenge centers on talent. The competition to recruit and retain qualified individuals that will help take the business to the next level is always tough. With calls for increased transparency and self-service options, there also is a need for talent with a different mindset and skillset than revenue cycle teams may have hired historically. Today, talent needs to be able to manage transactions as well as exceptions, troubleshoot and solve problems independently as well as make customer service their top priority.
5. Nola Wyatt, vice president of revenue cycle for St. Louis-based Ascension: As we remain committed to our quadruple aim of delivering exceptional health outcomes; ensuring an exceptional experience for those we serve and providers; and making healthcare delivery more affordable, our revenue cycle team is transitioning our operations to have a more consumer focus to support our care delivery.