The healthcare revenue cycle has undergone drastic changes since the ACA's passage. With more changes poised to come, it's important for healthcare revenue cycle professionals to leverage metrics, technology and human capital to maximize payer reimbursement.
During a Sept. 21 discussion at Becker's Hospital Review 3rd Annual Health IT and Revenue Cycle Conference in Chicago, Rudy Braccili, the recently appointed director of revenue cycle for Nicklaus Children's Hospital in Miami, offered insights into revenue cycle metrics, technology and staff management, among other topics.
Prior to joining Nicklaus Children's, Mr. Braccili served as the executive director of revenue cycle services for Boca Raton (Fla.) Regional Hospital, where he oversaw a complete financial turnaround. When he joined the hospital in 2009, Boca Raton Regional faced a $124 million loss, in part because it gave more money back to CMS' Recovery Audit Demonstration program than any other hospital in the nation. By the end of fiscal year 2014, the hospital posted a $1.2 million annual profit and an annual net income of $5.2 million.
Here are three revenue cycle insights from Mr. Braccili.
1. On revenue cycle metrics: Mr. Braccili cited the number of claims aged over 180 days, cash revenue compared to cash goal, clean claim rates and discharge not final billed over three days as a few of the key benchmark metrics for the revenue cycle. Additionally, Mr. Braccili described DNFB and clean claim rates as being inversely related.
"[The two metrics assess] how fast am I getting my claims out the door versus how clean are my claims," said Mr. Braccili. "I'm a fan of let's not get it out so fast, let's make sure every claim that goes out is clean, so it gets paid, but that means my DNFB is going to be up. I'd rather have it be up than have a claim go out, [be rejected] and have to go through all that rework. Be careful not to demand low DNFB rates from your business office without keeping an eye on what those rejection rates are."
2. On technology solutions: Mr. Braccili placed an emphasis on the importance of outfitting currently available mainframes like Cerner, Epic and Allscripts with bolt-on technology solutions. The revenue cycle leader described the implementation of a changed insurance verification system as the most helpful technology in his new position.
"We found [an insurance verification system] that standardizes responses from the payer instead of having to look at 50,000 different responses. That does something with the data that it gets back, so it sees that it's a Medicare HMO patient, and it brings it to the attention of the registrar so they make sure they get the authorization."
3. On staff engagement: In his new position, Mr. Bracilli meets with collectors to analyze the highest dollar accounts over 180 days once a week. He said this is important to help his team identify key accounts and give his team a mission.
"The very first thing I do is walk in and say hello to everyone on the floor. That is sometimes radical because I let the employees know who I am and why I'm there, and they let me know who they are and why they're there," said Mr. Bracilli. "It's all about the rank and file. That's where the solutions are … and that's not a fluffy answer, that's the truth."
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