Many of the obstacles in revenue cycle are within healthcare leaders' power to dismantle.
This article appears in the July/August 2019 edition of HealthLeaders magazine.
Many elements of insurance, coding, billing, and other revenue cycle processes remain a mystery not only to patients, but to clinicians and others within the healthcare continuum. Because of this enigma, it sometimes seems within the organization as though the revenue cycle exists and operates in a vacuum, separate from the rest of the hospital, health system, or physician practice.
But in reality, it’s exactly the opposite. The revenue cycle’s functions and outcomes affect everyone in the organization, whether they realize it or not. Its functions also extend to entities outside the organization, from patients to payers to prospective employees.
Confusion about revenue cycle's function is one of several barriers to improving it, but leaders must realize that the obstacles are within their power to dismantle.
At the March 2019 HealthLeaders Revenue Cycle Exchange in Ojai, California, 40 executives shared six barriers to revenue cycle success with proven approaches to overcome them, as well as initiatives they'd like to implement. They are as follows:
1. Price transparency requirements
Everyone is demanding more transparency, from lawmakers to CMS to patients. But as systems increasingly go beyond simply publishing the chargemaster (which revenue cycle leaders agree isn't helpful to patients), they're finding that providing price estimates before a patient’s services can be tricky. Should estimates be guaranteed? Should they include a written disclaimer?
It's no wonder, then, that Exchange participants say their systems are breaking down the price transparency barrier in different ways. Some are providing estimates on surgeries, radiology tests, and office procedures that are scheduled. Others provide estimates for procedures that address non-life-threatening conditions and are postponable, such as knee replacements.
2. Lack of clinician engagement
Helping physicians see the bigger picture when it comes to documentation, coding, payments, and understanding the revenue cycle, in general, is important to everything from denials to cash flow for the organization's financial viability.
That's why many Exchange participants say they are engaging physicians and educating them in these financial processes, and using physician champions to act as liaisons between clinical and revenue cycle departments.
Leaders also stress the importance of "translating" information between revenue cycle staff and clinicians in a way that resonates with physicians.
3. Poor payer relations
Payer-provider relationships can be tough to navigate sometimes, but they don’t need to be adversarial when trying to work through claims. Instead, the relationship should be well-managed through clear and ongoing communications and open dialogue, say Exchange participants.
Well-functioning relationships with payers require having regular processes in place to monitor payer changes—and being able to officially object to them, if needed—as well as including language in contracts that prevents costly surprises. From having a dedicated team examine monthly payer bulletins to employing technology to speed up information sharing, leaders say they are working to break down barriers with payers.
4. Departmental silos
In an ideal world, the revenue cycle would operate like a well-oiled machine, each function flowing seamlessly into the next without snags or interruptions.
But often, even the disparate functions within the revenue cycle itself are siloed and don’t understand each other or work well together. Communication, accountability, and a commitment to a shared goal is key, Exchange participants say.
5. Lack of sufficient IT resources
Even revenue cycles with leading-edge IT tools must balance the demands of everyday tasks and daily business needs with the upheaval of big projects, new launches, and near-constant upgrades, not to mention the dizzying number of options for revenue cycle IT solutions.
In addition, while some Exchange participants say they have dedicated budgets and teams just for the revenue cycle, others struggle to get IT resources. That's why, they say, success depends on innovative partnerships with both outside vendors and internal IT departments.
6. Inadequate team member knowledge
As revenue cycle functions become more complex, leaders are recognizing that success depends on having a team of competent people working on behalf of patients and the organization's bottom line.
For one Exchange participant, the need for better training came into sharp focus when they said they realized that some of their staff who talk with patients about price estimates didn't understand the difference between coinsurance and deductibles.
Leaders noted the need for higher knowledge and skill sets in registration and other patient-facing roles, as well as the need to proportionally adjust the salaries, benefits, and promotional ladder to attract high-performing employees and to retain them by ensuring a rewarding career track.
To read first-person accounts of how revenue cycle leaders are working through these issues in their own organizations, download our new HealthLeaders Revenue Cycle Exchange Insights Report.
The Revenue Exchange is one of six healthcare thought-leadership and networking events that HealthLeaders holds annually. While the events are invitation-only, qualified healthcare executives, director-level and above, will be considered. To inquire about the HealthLeaders Exchange program, email us at email@example.com.
Alexandra Wilson Pecci is an editor for HealthLeaders.
Photo credit: Pictured above: Jessica Johnson, Director, Middle Revenue Cycle, Hennepin Healthcare (Photo: David Hartig)
'Translate' revenue cycle functions for clinicians to help them understand their role in the organization's financial health.
Standardize open, clear, and ongoing communications with payers.
Equip revenue cycle employees with more training and reward them for their specialized knowledge and skill.