There is no doubt that today more than ever before, it's crucial that a health system's revenue cycle capture every dollar that it possibly can. Historically, many organizations have gotten caught up in managing and monitoring revenue cycle operations, but experts say the starting point to building a truly efficient and successful revenue cycle begins with shifting the collective mindset from thinking just operationally to taking a more strategic view. Leaders must make sure they are critically evaluating components of their revenue cycle from both a qualitative and quantitative way.
Eric Fontana, practice manager at Advisory Board, said leaders must first understand what their capabilities are today and where they are on "the spectrum from lagging behind the market to transforming the rev cycle and where to improve."
As an example of a more strategic mindset, a rev cycle leader might oversee multiple sites in a large system and look at why there are duplicate functions across different sites and streamline from there. Large systems where one hospital is doing really well can be looked at as a model, with their intellectual capital then being expanded across the system by identifying best practices and rolling them out system wide.
Leaders who are looking to take their revenue cycle into the future need to focus on a few key areas:
1 Provide a better patient financial experience. It's not just about price transparency and the emerging trend of shopping around for services. It's also about how we interact with patients and make it easy for them to pay, like providing the necessary financial decision-making support and front loading it in the process so that patients get immediate access to the services they need and can make informed financial decisions. Improving price transparency, better front office performance and better billing and collections are all components of an improved patient financial experience too.
2 Reduce denials from payers. Denials have been on the rise over the last few years. Payers are more aggressive in denials and are making it more difficult to appeal denials, increasing the need for greater to efficiently managing them.
3 Running a more efficient rev cycle. At the heart of rev cycle challenges is running an efficient operation such that the cost to collect is not higher than it could or should be. Leaders should be thinking about where opportunities for efficiency are, Fontana said.
4 Don't forget about ambulatory revenue cycle operations. Previously thought of as an inpatient-focused function, that view is shifting as outpatient services become a bigger proportion of business. Revenue cycle leaders must meet the challenge of extending the vision to the outpatient enterprise.
5 Make your mid-cycle more accurate. How rev cycle leaders enhance clinical documentation, coding and how they engage their clinicians all can have an impact on the bottom line.
6 Take steps toward operational improvement. This begins with engaging staffers because they play a pivotal role in capturing crucial revenue. For large systems with multiple sites, it also includes ensuring that revenue cycle operations are integrated and cohesive.
7 Monitoring regulatory changes. Healthcare executives and rev cycle managers alike should track payment rules and regs as they come down and be proactive about analyzing how those changes could alter workflows and policies.
What's next? AI and machine learning are coming
While Fontana said that a best-in-class rev cycle would encompass tall of the above, hospital business decision makers should also be anticipating emerging technologies.
Is there room for AI in the revenue cycle? You bet there is. In fact, it should become a standard part of rev cycle operations before too long.
Bob Mueller, vice president of revenue cycle for St. Luke's Health said he expects the rev cycle of the future will have to include that type of intelligence.
"I don't think healthcare, from an understanding of the finances, is going to get any simpler," Mueller said. "We constantly have to take on the response of informing our patients in everything we communicate and do so in such a way that they understand it."
Nick Giannasi from Change Healthcare predicts AI will all but take over the usual revenue cycle functions, but said don't forget about the human element too. He added that rev cycle will become AI and machine learning powered except for small groups of people handling more complicated claims that don't fit within the framework of an AI tool or machine learning algorithm.
"You will have humans looking at the complex rare cases. And that's really a nice interplay of how you get good at doing everything," Giannasi said. "You have humans do what they are really good at and take them off what they are bad at."
Fontana agreed on the needed combination of AI and human influence. He said hospitals shouldn't lose sight of the reality of "people, process, product."
"If you go out and buy a super expensive product but don't optimize what the people and the process are about," Fontana said, "then you've just bought yourself a more expensive version of the same problem."
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