Improving revenue cycle performance has become more challenging amid today's healthcare payment trends and patient financial expectations.
To gauge efforts at hospitals and health systems, Becker's Hospital Review asked healthcare leaders to share changes their organizations have made to improve revenue cycle performance this year. Read their responses below, presented alphabetically.
Editor's note: The following responses were lightly edited for length and clarity.
Venkat Bhamidipati
Executive vice president and CFO of Providence St. Joseph Health (Renton, Wash.)
We've made many substantial changes to transform our revenue cycle processes and performance at Providence St. Joseph Health. Perhaps the most newsworthy item was our acquisition of Lumedic, a revenue cycle platform based on blockchain technology. We plan to be the first integrated delivery system to establish a scalable blockchain platform that will help resolve many of the real challenges in claims processing and interoperability between payers and providers. Our Lumedic team continues to advance their technology and assets, and we are in active discussions with multiple payers regarding how we partner to coordinate financial transactions, lower administrative costs and improve the financial experience of healthcare for patients.
That said, when I consider our day-to-day operations at Providence, what stands out most to me is how our revenue cycle team has accelerated our use of insights and analytics. Even functions as simple as visualization tools have enabled greater access to and engagement with data among our revenue cycle and finance colleagues. This has made a real difference. We have more conversations, and more problem-solving conversations that advance us toward issue resolution, than before. Managing and expanding access to information has been a turnkey for us, and I'm excited about the work our teams will be doing to build on this foundation.
Kelly Black
Vice president of revenue cycle at Novant Health Medical Group (Charlotte, N.C.)
An automated payment technology vendor was sending Novant Health Medical Group approximately 17,000 individual insurance virtual credit card payments totaling $6 million annually. The average per claim payment amount was less than $10. These virtual credit card payments had to be processed, reconciled and posted manually.
Novant Health Medical Group revenue cycle worked with the vendor to convert these payments to EFT [electronic funds transfer] deposits and the associated payer remittances to electronically postable 835 files. We also partnered with the automated payment vendor and our clearinghouse on a process to transfer the converted payment files into the clearinghouse's remittance manager. This allowed these transactions to follow our normal automated cash reconciliation process.
Novant Health Medical Group saved approximately $300,000 annually as a result of the efficiencies gained. Previously, the lift was heavy as FTEs [full-time equivalent workers] keyed the credit card information for processing, batching and scanning the manual remittances — then manually posted the payments. The solution allowed us to automate the entire process with no manual intervention and reduce the number of FTEs needed to process the payments.
Gerard Brogan Jr., MD
Senior vice president and chief revenue officer at Northwell Health (New Hyde Park, N.Y.)
This year we have very aggressively deployed the utilization of bots for robotic process automation technology to make tasks that are highly repetitive and have low levels of variability as automated as possible, freeing up staff for more labor-intensive functions within the revenue cycle. That's probably yielded the greatest efficiencies and the bigger process/operational change in the revenue cycle of anything we've found.
We found that the front, middle and back [of the revenue cycle] all have opportunities for this type of robotic process automation technology. We happened to start at the back end first as well as the middle because of the opportunities identified there first.
Todd Craghead
Vice president of Intermountain Healthcare's revenue cycle organization (Salt Lake City)
Intermountain has enhanced its digital footprint, which includes integrated tools to help the patient better understand and manage their financial obligations. We've seen an improvement in the patient financial experience through increased adoption of our online, self-service payment portal. This digital tool allows patients to consolidate and pay their bills, including the flexibility to set up payment plans through the online tool.
Donna Graham
Executive director of revenue cycle at the MetroHealth System (Cleveland)
This year, the MetroHealth System and Hyland, [a healthcare software provider], collaborated on the development of Hyland Content Connect. This software enables the two-way, seamless, secure digital exchange of data [medical records] between healthcare payer and provider organizations.
This collaboration bypasses traditional, time-consuming communication through fax, mail, couriers and web portals thereby reducing costs and eliminating risks and [payment] delays through increased transparency, quality and faster processes. It tracks requests and resolution based on auto date stamps.
In addition, the information is trended to reduce unwarranted requests and streamline processes for the provider and payer. Leveraging Hyland's OnBase information management platform and the MetroHealth System's clearinghouse as the intermediary, the solution enables these workflow and business process management functions without complicated system integrations. It is a portable solution that can be used by any healthcare system, payers and clearing houses. This is a financial solution expediting cash at a lower cost, while at the same time a win for the patient/member in closing the gap between their clinical care and receiving their explanation of benefits.
Melissa Masterton
Vice president of revenue cycle for Novant Health acute care services (Charlotte, N.C.)
At Novant Health, we implemented a new tool to audit a larger volume of our inpatient accounts for DRG [diagnosis-related group] accuracy. For many years, our team audited a random sampling of various DRGs to determine accuracy. However, this manual chart review was very resource-intensive, time- consuming, costly and represented a very small sample of our total inpatient volumes. A new DRG validation tool is allowing us to audit nearly 100 percent of our inpatient claims for DRG accuracy across the Novant Health footprint in 48 hours or less.
In addition, our team is utilizing the feedback to build stronger safety nets within our EHR platform to reduce the number of DRG errors at the time of production coding — and ultimately improve our DRG accuracy. This additional safety-net approach within the EHR will allow us to create real time feedback to our production coders with specific details on why something appears to be coded incorrectly — not several months later.
Although we expect 1 percent or less of codes to be corrected, under this new audit scope, we are increasing our coding DRG accuracy and capturing the appropriate revenue for the organization.
Matthew Muhart
Executive vice president and chief administrative officer of Memorial Healthcare System (Hollywood, Fla.)
Memorial Healthcare System recently revamped its approach to reduce medical necessity denials from managed care payers by adopting a real-time hospital and managed care physician peer-to-peer review of the clinical conditions supporting the appropriate placement of select patients. This front-end approach improved the timeliness, and ultimately, the amount of collections and reduced the administrative burden associated with contesting denials months after the date of service.
Britton Tabor
Executive vice president and CFO/treasurer of Erlanger Health System (Chattanooga, Tenn.)
I believe that revenue cycle is not just a finance function. A well-run revenue cycle is dependent on the total team. The team should be inclusive of all the constituents, including physicians. At Erlanger, we have engaged our physicians at the hospital service line level to review all the pertinent metrics of revenue cycle, including but not limited to denials, coding, pre-cert requirements, contribution margin, etc. Quarterly service line meetings are held with the entire team to review outcomes. Meeting participants include billing, HIM [health information management], revenue integrity, physician leadership, clinical leadership, business analytics, CDI [clinical documentation improvement] and utilization review. The outcome of this type of engagement generates an extremely knowledgeable service line physician who is also a fiscally responsible champion for the health system.
Rachel D. Verville
Chief revenue cycle officer of Allegheny Health Network (Pittsburgh)
At Allegheny Health Network, we are focusing on two overarching revenue cycle priorities this year: creating seamless and positive patient experiences, and enhancing overall efficiency to improve outcomes.
From a patient-experience perspective, we take very seriously the role that revenue cycle plays in shaping that experience, and we know that we often create the first and last impression that our patients and their families have of our organization. From our first contact with patients prior to arrival, to the final bill, our goal is to create an exceptional experience, taking the hassle out of healthcare.
In support of that goal, we are enhancing our financial advocacy framework to provide timely, comprehensive and meaningful financial information to patients, including support for resolving financial responsibility. We are also leveraging tools and technology to automate patient estimates and working to make such estimates available through various avenues and portals.
From an overall efficiency standpoint, we are continuing to leverage robotic process automation as we work to minimize repetitive processes and manual routines that bog down revenue cycle functions. By freeing up our talented workforce to focus on advanced analytics, root-cause evaluation, and patient support, we will reduce cost, improve overall financial performance and ensure positive patient experiences.
Joshua L. Welch
Executive director of revenue cycle at John Muir Health (Walnut Creek, Calif.)
The single largest move that we have made to drive rev cycle performance this year is the Optum/JMH partnership. [On] July 16, JMH announced a partnership with Optum Health, which involves not just revenue cycle, but rather a bundle of administrative services, including [information technology], analytics, e-business, risk management, outpatient utilization management and purchasing. This move will accelerate several initiatives:
- Automation – Claims status, auto authorization
- Clinical documentation improvement optimization – Replacement of our computer-assisted coding and reporting capabilities
Independent of the Optum partnership, we have been working on several other initiatives this year including:
- Denials avoidance – Improved Epic workflow and communication between patient access and case management which has significantly improved the authorization process
- Patent engagement – Advanced some of the MyChart capabilities (electronic check-in and copay and prior balance payment processing, among others)
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