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Analysis

3 Twists on Common Revenue Cycle Issues

By Alexandra Wilson Pecci  
   March 10, 2020

Denials, automation, and surprise billing are perennially tricky issues, but new twists on those topics add an extra layer of complexity.

When it comes to revenue cycle management, a handful of issues are nearly always a struggle, year after year.

For instance, denials, automation, and surprise billing are perennially tricky topics for leaders to cope with. And for every new solution that revenue cycles implement to solve those problems, a new twist creeps up that adds an extra layer of complexity.

That's why revenue cycle leaders must constantly assess the healthcare landscape and move quickly and nimbly to address challenges.

At the upcoming HealthLeaders Revenue Cycle Exchange in April, innovative leaders from around the country will be meeting to discuss these issues and share how they're dealing with them.

Here are three hot issues they'll be discussing.

Issue 1: Denials and underpayments

The twist: Payer audits, level of care changes, and more

Dealing with issues like denials and underpayments has always been tricky, but recently, payers have been adding new complications such as payer audits and level-of-care changes. That's why revenue cycles need to implement new strategies for dealing with such practices.

For instance, Southwest General Health Center in Middleburg Heights, Ohio, has recently started to address commercial payers’ audit practices that can result in things like DRG reassignments, charge deletions, and significant underpayments, says Jill Barber, executive director of payer strategy and population health.

"We are implementing a new workflow and tracking tool and dedicating new FTE resources to this project," she says. Barber will share details of that work at the Revenue Cycle Exchange, including the reasons revenue cycles should investigate their own experiences with this type of audit activity; calculating the financial and other impacts such audits have on organizations; and considering more active strategies to combat them.

Issue 2: Automation

The twist: Artificial intelligence

Automation in the revenue cycle is nothing new, but the buzzword—artificial intelligence—seems to hold equal amounts of promise and trepidation for executives. Chris Thomas, corporate vice president of revenue cycle/CBO at Scripps Health in San Diego says he wonders what AI means for healthcare? Where is it at its best to drive value, and where is it problematic and prone to errors? he asks.

For Angela Simmons, vice president of revenue and reimbursement at Vanderbilt University Medical Center in Nashville, actually seeing how AI works is incredibly important, she says, such as seeing real-world, hands-on demos of tools like a work bot that fixes registration errors and claims edits 24/7. 

As she and other revenue cycle decision-makers move forward with implementing automation and AI, they'll need to see more robust examples of how it works in practice, including success stories, they say.

Issue 3: Surprise billing

The twist: Red-hot scrutiny and possible new rules

From health system execs, to patients, to the president of the United States, there are two words that seem to be on everyone's lips when it comes to talking about unacceptable problems within the U.S. healthcare system: Surprise billing.

"Surprise billing is a hot, relevant topic," and also one that can be a "PR nightmare," says Patrick McDermott, vice president of revenue cycle at Sutter Health in Northern California. That can be especially true if a patient's huge, unexpected surprise bill makes the local or national news.

In addition, data supports the idea that surprise billing is worrisome. For instance, an eHealth survey showed that two-thirds of Medicare enrollees are worried about receiving surprise medical bills, and almost 40% of enrollees said having an in-network provider was their top concern when receiving medical care.

These concerns are well-founded, according to other new research, which shows that about one-in-five patients undergoing elective surgeries at in-network hospitals is slapped with an out-of-network bill.

Those bills were an average of $2,011, with most of the out-of-network billing attributed to surgical assistants or anesthesiologists.

However, there may be an attempted solution in sight that revenue cycle leaders should keep on their radar: The House Ways & Means Committee released its proposal to curb surprise medical billing last month, which includes a provision to establish an independent mediated negotiation process for billing disagreements.

Share your insights and ideas with other revenue cycle VPs and leadership facing the same challenges by attending the Revenue Cycle Exchange April 20–22, 2020, in Carlsbad, California.

The Revenue Cycle Exchange is one of six healthcare thought leadership and networking events that HealthLeaders holds annually. To inquire about attending a HealthLeaders exchange, email us at exchange@healthleadersmedia.com.

Alexandra Wilson Pecci is an editor for HealthLeaders.

Photo credit: Angela Simmons, vice president of revenue and reimbursement at Vanderbilt University Medical Center at the December 2019 HealthLeaders Revenue Cycle Exchange. (Spencer Selvidge)


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