Hospitals and health systems face various revenue cycle challenges including healthcare consumerism and complex reimbursement models.
Becker's Hospital Review asked healthcare leaders to share their top revenue cycle challenge and how they are addressing it.
Note: Responses have been edited lightly for length and clarity.
Dalton Huber
CFO of Campbell County Health (Gillette, Wyo.)
We did a computer implementation … where we brought our clinics onto our EHR, which is Meditech. We went through a computer conversion, and at the same time we combined the physician billing offices and the hospital billing offices. Our goal was to get to one bill for hospital and physician.
We integrated [those changes], and what transpired was … a rise in [accounts] receivable. Our No. 1 priority is to see that stabilized …We've started already, but that's our focus — to get our computer systems aligned with what we're trying to accomplish, and that's an efficient billing process.
Debra Lowe
Head of Revenue Cycle at The Ohio State University Wexner Medical Center (Columbus)
Our top revenue cycle challenge is the overall complexity of the healthcare reimbursement system and the resulting lack of understanding from not only the general public but also healthcare professionals.
Complex benefits structures and payer networks; ever-changing payer policies on requirements for covered services; evolving technology such as virtual health with ill-defined payment policies; and the substantial administrative burden to justify payment for all the services provided causes frustration with the system and drives up providers' costs. The challenge for the revenue cycle is to maximize reimbursement for the organization and at the same time enable processes that provide a pleasant experience for the patient in navigating their journey from scheduling an appointment to resolving their financial obligation.
We address these challenges by recruiting and developing talent while leveraging automation to control costs. We endeavor to optimize the tools we have to develop and maintain lean processes. We have developed a relationship with industry colleagues to share knowledge and best practices to aid each other in producing a cost-effective, quality product.
Dan Rieber
CFO of UCHealth (Aurora, Colo.)
As more people sign up for high-deductible insurance plans, we're seeing an increase in requests for expense estimates specific to them. UCHealth is providing a solution to this within the EMR, by offering individualized out-of-pocket cost estimates for numerous services utilizing a patient's insurance plan information. Accessible via our online patient portal, mobile app and through a dedicated call center, UCHealth is now able to immediately connect with an insurance plan, confirm a patient's insurance information, and even identify how much of his or her deductible and out-of-pocket maximum the patient has already met during the plan year. The patient then can select from multiple UCHealth locations and services to compare costs and receive an estimate. Services include MRIs, CT scans, deliveries, orthopedic surgeries, cataract removal and more. This estimates tool gives patients the power to make informed healthcare choices, and it also can help guide patients as they select an insurance plan that's right for them.
Britton Tabor
Executive Vice President and CFO of Erlanger Health System (Chattanooga, Tenn.)
Erlanger made one of the largest capital investments in our history to replace an outdated EMR. As our organization transitioned to the Epic system, stabilizing the revenue cycle was a top priority. The new information that is being generated from the system and the improvements in work flows has significantly enhanced the patient experience and ensured efficiencies. In addition, payer stability was a key strategic priority for the system. We were able to execute key multiyear payer contracts to stabilize rates and provide network access for all our patients in the region. Finally, the net revenue for our system has grown double digits in the past five years. Ensuring the infrastructure is in place to support revenue cycle function in a rapid growth scenario is paramount.
Brian Unell
Vice President of Revenue Cycle Transformation and Integration at Piedmont Healthcare (Atlanta)
Piedmont Healthcare's top revenue cycle challenge is "content management," which involves using our EHR, Epic, to improve management of unstructured patient data and a variety of other functions. Content management is coming at us on multiple fronts:
- Payers are constantly changing requirements, which necessitates that we update standard operating procedures and training materials.
- We need to ensure that physicians are either credentialed or registering as "OPR" [ordering, providing, referring] with the state to provide Medicaid services.
- We also are capturing patient-specific information, such as a patient's primary care physician and his or her employer, to ensure appropriate follow-up for care and value-based arrangements.
To address, we are working with numerous stakeholders from employed and non-employed physicians and their offices, IT, managed care, hospital operations, front-line team members, as well as our patients on why this information is important for their clinical and financial care.