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Billing and Value-Seeking Dominate HFMA-ANI Conference

Analysis  |  By Christopher Cheney  
   June 27, 2016

The majority of the sessions at this year's HFMA-ANI conference reflect the quest for high-yielding billing processes and strategies to navigate the shift to value-based healthcare.

A pair of sessions on the first day of the Healthcare Financial Management Association's Annual Meeting in Las Vegas exemplified the event's thematic duality.

The unofficial high temperature in Las Vegas Sunday was 109F.

Fittingly, sweating the details was the primary message of "Creating Pristine Claims—Essential Practices for Revenue Cycle Success," held on HFMA's first morning of sessions.

"The most important process in the business office is billing," said Pamela Fell, corporate director of the central business office at Miami, FL-based Jackson Health System.  

JHS is a public hospital system with a total of 2,101 licensed beds in three acute-care hospitals, a children's hospital, a rehabilitation hospital and a behavioral health hospital.

In 2014, total patient service revenue was posted at $866 million. The system reported record profit in 2015.

To that ensure claims for reimbursement are paid, every detail matters, Fell said. "You have got to have everything; everything has just got to be perfect."

"Everything" includes registration information such as health plan data, as well as payer authorization, clinical coding, and revenue codes, she said.

The registration system is usually different than the revenue cycle system. It's very important to get information right on the front end—in the registration system, " Fell said. Otherwise, it can create a problem "every time a patient comes in."

Making sure physicians are preparing clinical documentation accurately is another key to billing success, she said. "They need to know what they are documenting and how that affects whether you get paid."

Clinical documentation is mainly a generational challenge, which is becoming easier to address over time as the importance of accurate clinical documentation is more widely expected and accepted.

"The younger doctors are much more receptive to this," Fell said.

"Thirty year ago, no one would have approached a doctor to talk about this, but payers have changed and the doctors have changed. This is just part of the landscape now."

Out-of-Pocket Estimates Boost Collections

One of the value-based healthcare sessions on Sunday focused on transparency and featured revenue cycle executives from a half-dozen health systems, including Greg Meyers. He is senior vice president of revenue integrity at Oklahoma City, OK-based INTEGRIS Health, which operates seven acute-care hospitals and a women's hospital.

INTEGRIS began offering out-of-pocket charge estimates to patients in 2006 through the health system's "Consumer Priceline" program, Meyers said.

The program has grown from 900 cost estimates done monthly through a manual process to 20,000 done monthly through an automated process.

Since launch, point-of-service collections have skyrocketed, rising from $900,000 in 2007 to $18 million in 2015, he said. "Our biggest measure of success is point-of-service collections. We're going to hit the $20 million mark this year." 

The vast majority of the sessions at this year's HFMA-ANI conference reflect the quest for detail-oriented billing processes and strategies to navigate the shift to value-based healthcare.

The billing-related sessions include focusing on generating positive return on investment, optimizing clinical documentation improvement programs, engaging physicians to support strategic service lines, and leveraging clinical insights to drive cost savings.

The value-based healthcare sessions address a variety of topics, including consumerism, helping physicians to deliver value-based care, harnessing data analytics, engaging patients as financial partners, and developing a telemedicine strategy.

The conference is scheduled to conclude on Wednesday.

Christopher Cheney is the CMO editor at HealthLeaders.

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