Technology plays a key role in nearly every step of the revenue cycle process. However, many healthcare organizations continue to struggle with technology adoption and optimization.
Fifty-six percent of respondents to a November Navigant/Healthcare Financial Management Association survey said challenges related to adoption of EHR and RCM technology solutions are equal to or outweigh the benefits. The survey of 107 hospital and health system CFOs and revenue cycle executives also found that 56 percent of respondents are unable to keep up with EHR upgrades or underuse EHR functions, up from 51 percent in 2017.
Amid these trends, Tim Kinney, managing director with Navigant in Chicago, provided the following thoughts on navigating revenue cycle technology challenges.
- Keeping the same number of full-time equivalent revenue cycle positions before and after an EHR adoption does not benefit the technology optimization process. Rather, hospitals should focus on creating more efficient workflow and optimizing the EHR. Mr. Kinney recommended putting the right people on the right account population for billing and follow-up with payers and allowing the system to prioritize the work.
- Hospitals often lack enough revenue cycle staff, including billers and representatives to follow up with payers, to manage patient accounts. To ensure claims are submitted and followed up on in a timely manner, Mr. Kinney recommended using technology that can help prioritize patient account populations. For instance, if an insurer allows 180 days for the hospital to file covered patients' bills, there is software available that can move those bills to the top of a representative's list to ensure the claims are submitted before the filing deadline, according to Mr. Kinney.
- Hospitals with self-pay data in the back end of the revenue cycle can determine how likely a patient is to pay his or her bill before the patient receives care. Mr. Kinney recommended organizations use this data — which may include historical payment activity and demographic information — to group patients by who is likely to pay after receiving letters and calls, who would qualify for financial assistance upstream in the revenue cycle, and who can afford a portion of their bill. "It's using the data, segmenting it appropriately, and … bucketing into one, two or three buckets on their likelihood to pay" and the best way to approach patients for payment, he said.
- Revenue cycle leaders and IT leadership should co-lead the technology upgrade and optimization decisions. Mr. Kinney said these leaders can weigh in on what will help them advance revenue cycle optimization either through net revenue improvement, cash acceleration or patient engagement.
- After a go-live, vendors may approach the hospital quarterly with up to 100 new EHR functions they could implement. Mr. Kinney recommended organizations implement the new functions that will drive operating margin or patient satisfaction improvements. "Focus on those, develop the work plan and see it through to implementation," he advised.
- Hospitals can help ensure the first bill sent to a payer or patient includes the correct charges for all services provided by having the revenue integrity team mine clinical data in real time. Mr. Kinney gave the example of a heart transplant patient. With the proper toolkit, "I can tell if all charges that should be there are there before the bill goes out the door. So that's an optimization effort that cuts down on late charge billing, rebilling on the back end, and it's all because the revenue integrity team can mine data on [the] clinical side [in] real time, capture it and make sure documentation is there and the bill is out the door correctly the first time," he said.