Ron Wachsman, vice president and chief revenue cycle officer of Memphis, Tenn.-based Baptist Memorial Health Care, takes a collaborative approach with his staff.
He said he realizes that the revenue cycle encompasses an array of processes and tries to ensure all people involved are focused on common goals.
"In today's environment, [the revenue cycle is] more of a team approach, it's not just the back-office finance operation. It's really an organizational approach to ensure the revenue [reimbursement] is appropriate," he said.
Mr. Wachsman previously served as senior vice president of revenue cycle for Prospect Medical Holdings, a Los Angeles-based for-profit hospital operator. He also was chief revenue officer of Memorial Hermann Health System in Houston. Before joining Memorial Hermann, he worked over two decades at ProMedica Health System in Toledo, Ohio.
Becker's Hospital Review recently caught up with Mr. Wachsman to discuss his leadership style and how he tells his staff to handle billing disputes with patients.
Editor's note: Responses were lightly edited for length and clarity.
Question: What is a typical day like in your role?
Ron Wachsman: With revenue cycle encompassing a broad area, I think that's why health systems have identified a need for more leadership in this area. Revenue cycle encompasses more than the traditional accounts receivable management. It really deals with many other areas that affect revenue for the organization. In addition to managing the billing process, we also want to work with patients to reduce our bad debt. We also work with operations to improve documentation to get paid what we're entitled, [and] make sure we're billing the appropriate level of care. I would spend time with all of those areas in a typical day. My role is to help facilitate communication with folks who impact the revenue cycle, educate [them] on how they impact the revenue cycle, really the revenue of the organization, as well as coordinate process improvement. In any day, there could be a number of initiatives we're working on.
Q: How would you describe your leadership style?
RW: To be successful in this role, [the work] has to be collaborative. There's a group of folks who work in the back office doing the billing and collecting. But there are a variety of individuals throughout the organization who aren't traditionally part of the revenue cycle but impact the revenue cycle. So we need to have a collaborative, team approach to make sure everyone's buying into the overall goals [of the system]. That's the most important part — to try to develop a team. A team of people that not only reports up through my division, but a team of colleagues that impact the revenue of the organization and make sure everyone's seeing things the same way.
Clearly, we [as a team] have to be well-organized. There are a number of things that have to happen correctly for a bill to get out the door accurately and get paid. There's a whole number of things that can go wrong between the time a patient is admitted into the system and the time an account gets processed, and any one of those things can cause an account to get denied. We want to make sure these processes are organized, and everything is working to protect the revenue of the organization. It's important to stay organized and make sure everything's working.
Q: If there is a billing dispute with a patient, how have you instructed revenue cycle staff to handle that?
RW: The engagement with the patient is a critical part of the revenue cycle, and it's a growing need for all health systems to focus on. If you look at the patient responsibility of the bill — just the folks who are insured and their portion — that represents about 10 percent of the overall revenue stream for the company. So it's very important for us to engage with patients, make it easier for them to pay the bill, make sure they have online capability to pay their bill, make sure they have easy access to us in our customer service area — really engage with them and help them understand their bill, and make sure we can resolve their issues. Some things can be handled online through our patient portal, but if someone needs to talk to someone, we have a call center and will work with them to resolve their dispute. We want to make sure the patient's comfortable with how things are billed. If there is a dispute relating to the services they were provided, that they feel were unsatisfactory, we'll forward that to individuals within the organization to look into that [as well].
Basically, any type of dispute they would have, we should be able to resolve. If they're unable to pay their bill, we have payment plans. For people without insurance, we have discounts we provide. We feel if there is an issue, we'll be able to work through it with the patient. The resolution of their account is the final impression that the patient has with our health system, and we want to do everything we can to get things right, so they're satisfied with that part of their experience.
Q: What advice would you pass along to other hospital revenue cycle leaders?
RW: Try to engage with other leaders in the organization, especially from the clinical operations area, to educate that leadership group on the importance of clinical documentation to ensure that the payment for that service is at the right amount. This involves documentation of services to make sure we can bill out the most appropriate diagnosis-related group. It involves making sure we have the right level of care. Sometimes insurance companies want to pay us as observation status when we can defend it as inpatient and get paid at the more appropriate, higher rate. There are also other things that affect how we code our claims. So, I think the more involvement with the clinical areas where they may not realize the impact they have on the final bill that goes out [is important].
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