In revenue cycle management, money talks. But so do revenue cycle leaders, and many of these professionals offered thought-provoking insights into the changing nature of the RCM industry this past year.
Here are six thoughts from industry leaders on the nature of revenue cycle management in 2015.
Emad Rizk, MD, president and CEO of Accretive Health (Chicago): "Overnight, I'd love to close the gap between the administrative and clinical sides of healthcare. The billing process is the first and last encounter patients have with a healthcare provider or hospital. The ease and timeliness of this process has an incredible amount of influence on patient satisfaction and how they gauge their care experience overall. Yet too often, billing is thought of as something completely separate from care."
Carolyn Rubin, vice president of revenue cycle innovations at Anthelio Healthcare Solutions (Dallas): "It takes a team approach for effective financial management. Gone are the days of working in silos. It is important to educate every member of every department on what revenue cycle is and how their role plays a part of it. Once they understand how they are impacting quality patient financial care, they want to learn more. I found the secret to success is to involve them, give department goals, set benchmarks, and share the results. Implement weekly meetings to review opportunities that have been identified, review processes, discuss challenges and get their input."
Monte Sandler, executive vice president of NextGen RCM Services (Hunt Valley, Md.): "If you look at a traditional billing office, it's a very reactive process. Providers are providing care, documenting their services and coding. A billing office is getting charges entered and bills out the door. Then, they basically wait until they get responses from clearinghouses or payers in the form of rejections and denials. Then, they react to those.
It's a terribly inefficient process. It delays the payment cycle. It reduces the probability of payment. I'm a big proponent of flipping that whole cycle upside down to build a much more proactive revenue cycle. Diligence is needed to scrub claims to make sure they're clean before they go out the door. Every practice should know if a patient is eligible before the doctor sees the patient. … It's solvable."
Ben Colton, senior manager at ECG Management Consultants (Boston): "Unfortunately, revenue cycle management is often a thankless role with an unclear career path and, therefore, does not always attract top talent. You're not typically getting a lot of young professionals who say, 'Hey, I want to get into healthcare billing.' Subsequently, management positions are often staffed by individuals who were promoted from line-level positions. To that end, organizations need to invest in ongoing training and development."
Tom Ferry, president and CEO of Curaspan (Auburndale, Mass.): "There's a push to move patients from the most costly setting to a less costly setting. Everything from outpatient treatment to lower skilled nursing stays, lower rehab stays, more home care treatment obviously lowers the overall cost of care for any particular episode. If you're thinking of it strictly from a fee-for-service perspective, you're going to have a lower length of stay. That, in the short term, potentially lower revenues because of those shorter hospital stays. When you think of it from a value-based perspective and potentially getting reimbursed on the total episode of care, whether it happened within an acute care setting or not, the profitability of that care will start to play into account. It's a lot less about total revenues and a lot more about margin."
Catherine O'Leary, managing director of KPMG (Chicago): "You want to get every dollar you're entitled to. You want to receive payment as fast as possible. And, you want to make sure you're doing it in a legal manner. That's the core of a revenue cycle."