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Revenue cycle directors more important than ever, experts say, as responsibilities grow

From ICD-10 to payer negotiations, these executives have more than enough to focus on.

David Weldon, Contributor

One of the greatest challenges for RCM directors this summer is ensuring that the organization has enough skilled coders to handle the demands of ICD-10, which will more than quadruple the number of procedure designations required for patient documentation and payment reimbursements.One of the greatest challenges for RCM directors this summer is ensuring that the organization has enough skilled coders to handle the demands of ICD-10, which will more than quadruple the number of procedure designations required for patient documentation and payment reimbursements.

If revenue cycle professionals have any doubt that they are expected to drive business strategy today, they need only read the job description for Emerson Hospital's desired new senior director of revenue cycle.

Words such as "oversight", "execution", "leadership", "mediating", "best practice", "core values", and "communicates" all leap off the page as must-have skills and qualities for anyone likely to be considered for the role in this Concord, Massachusetts healthcare center.

It's no wonder, considering everything on the plate of revenue cycle managers and directors. A growing number of hospitals and healthcare centers are making the move to population-based payment systems. Mergers and acquisitions continue at a healthy pace in the healthcare industry. And then there's ICD-10 – which is expected to finally take effect on October 1.

[Also: Hospitals struggle to find good revenue cycle candidates as demand rises]

Those challenges are taking center stage in job descriptions for RCM directors nationwide this summer.

In Escondido, California, for example, CHMB wants a candidate who demonstrates "effective and constructive problem-solving, collaboration, acting as a change agent and action planning related to both internal and external operational improvements." And, stresses CHMB, "strategic creative thinking and innovation are key to success, ensuring CHMB maintains optimal fiscal responsibility while meeting business needs."

The good news: revenue cycle managers can expect "generous" pay if they pass muster, according to July data from Payscale. Not surprisingly, "Career duration is the biggest factor affecting pay for this group followed by geography," the pay site noted. Pay rates for directors of revenue cycle management range from $63,018 to $142,837, with a median of $97,558.

A bigger job

Along with larger paychecks come greater expectations of course, especially when it comes to mitigating revenue challenges.

Janine Ricci, director of revenue cycle at the Austin Cancer Center, sees three big challenges.

[Also: HIMSS Revenue Cycle Solutions Summit: Call for proposals]

"Reimbursement is number one. Having insurance payers not only pay you correctly but on time is number two. Recruiting and retaining individuals with direct experience in the oncology world is number three," she said.

Ricci is knee-deep in the type of changes coming to many RCM roles. She joined the Austin Cancer Center staff in 2011 and immediately embarked on a project of integrating all billing, collections and medical revenue cycle initiatives into one centralized business office environment.

Ricci also knows all too well the difficulty in finding qualified revenue cycle professionals. She moved from Las Vegas to take her current post in Austin, Texas. That is typical of recruiting in this space now, as hospitals and healthcare centers cast an ever-widening net to find experienced candidates.

"You can add about 20 percent on to the cost, and then giving them incentives to come on board and to move to an area that they otherwise wouldn't have thought of is challenging," Ricci said. In addition to the greater cost of recruiting, the time to fill positions is also increasing.

"If you need somebody for three weeks from now it doesn't mean that you're going to fill that position," Ricci said.

All eyes on ICD-10

Of the challenges discussed above, ICD-10 is the most pressing, said David Lane, a healthcare revenue cycle management consultant in Chattanooga, Tennessee.

"The big question mark is how that is going to affect payers and processing, especially the [hospitals and healthcare centers] that may not have done a lot of testing, or smaller rural facilities that do not have a lot of day's cash on hand."

[Also: As EHR, revenue cycle tools overlap, experts say there's room for both]

One of the greatest challenges for RCM directors this summer is ensuring that the organization has enough skilled coders to handle the demands of ICD-10, which will more than quadruple the number of procedure designations required for patient documentation and payment reimbursements.

"A lot of physicians have been complaining about ICD-10, and they have been the main ones complaining about it because you're going from about 16,000 diagnosis and procedures to somewhere around 80,000 or a little more. You have to go into more detail with the documentation. If you're not good on the documentation than your reimbursement will suffer," Lane said.

This has fueled a hiring spike for healthcare IT pros this year, and the hospitals that are most successful in that struggle may be best poised for the Oct. 1 implementation of ICD-10.

At the same time, the RCM directors that are most successful in their roles this summer are those that have best prepared the organization for that "go-live' date.

"You have to have gotten in on testing and have your staff and your coders educated," Lane stressed. "You have to have your coding resources in place. You have to have educated your physicians, hopefully. You would want to have started dual diagnosing – if you are not doing it now you would want to start it sometime in August or September in order to prepare for the Go-Live."

The ICD-10 implementation date could disrupt hospitals and healthcare centers for several months in terms of seamless billing, Lane warned. That means RCM directors had better have a Plan B in mind.

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"You would have probably looked for some short term financing for trying to hoard some cash for the go-live. You may be able to line up some lines of credit. You may be able to stretch your payables out a little bit. Some of those may be short term measures. In longer term you have to have an emphasis on accelerating cash, liquidating the receivables that you have on the books prior to ICD-10," Lane said.

The RCM director must learn to be "a jack of all trades," Lane said.  "You have to be a gatekeeper, to be able to provide knowledge or get answers for senior management. You have to watch trends, be a good communicator, a good mentor, provide tools and resources to your staff, and be able to identify obstacles to their productivity and improvement and be able to remove those."

Finally, "you have to make sure that throughout the revenue cycle, from the time a patient is presented for admission until the time that the bill is paid and resolved that you provide the information required that the patient has the best experience possible," Lane said.

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