Keeping up with payer changes
A major obstacle for the revenue cycle is trying to stay apace of the steady stream of changes from payers, says Keith Eggert, vice president of revenue management at Orlando Health, a 1,780-bed family of facilities based in central Florida.
"One of the biggest challenges has to do with keeping up with payer changes as payers are adopting different classifications for denials, whether it be partial denials or penalties. The game is constantly in flux," he says.
Orlando Health is always "trying to keep the revenue cycle ahead of (the changes) so we don't end up being penalized financially for not jumping through a hoop," Eggert adds.
In an effort to be as prepared as possible to stay ahead of payer shifts—and to handle a host of other revenue cycle functions—Orlando Health has spent the last four to five years automating most of its revenue cycle processes, Eggert says.
"If you are a totally manual operation, then you are reliant on someone to see a trend," he says, noting that with an automated process, it is easier to spot patterns in claim denials through the reports and daily dashboards the system generates.
The real-time data that is available is invaluable for identifying these trouble spots, Eggert says. "Not that you can solve it right away, but at least you are aware of it."
Bob Reilly, chief financial officer at Anne Arundel Health System, a 324-bed system in Annapolis, MD, thinks the toughest challenge impeding successful revenue cycle management is all the ambiguity surrounding the change in payment models and what that will really mean to the business of healthcare.