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Fee-for-Value: Is Your Revenue Cycle Ready?

By Optum  
   February 21, 2017

Healthcare organizations are adopting innovative practices as they prepare for a new future

"The modern revenue cycle is becoming much more efficient using a technology platform that brings intelligence to the process." —Todd Gustin, SVP and general manager, revenue cycle technology solutions and professional services at Optum360

Today’s hospital revenue cycle wasn’t designed to handle the rapid changes taking place in healthcare—which is why it’s getting a much-needed overhaul, according to Todd Gustin, SVP and general manager, revenue cycle technology solutions and professional services at Optum360. "Much of the industry’s revenue cycle initiatives have been focused on resolving symptoms without getting to the root cause of challenges. This is why healthcare organizations require a more holistic approach that Optum360 offers," says Gustin. Hospitals and health systems need advanced solutions that support both where they are today in the fee-for-service world and the new processes they’re developing in light of the changing operating environment and healthcare economy.

Gustin says the modern revenue cycle can do just that. It’s flexible, easy to scale, and can quickly adapt to everything from new regulations to evolving industry dynamics. This is because it incorporates three key components: cost-saving automation, efficient staffing, and standardized technology. "As the transition to value-based care increases over the next couple of years, now is the time to take action and assess your revenue cycle’s readiness to continue to support both of these environments," he says.

Identifying top targets for cost-saving automation

The modern revenue cycle system helps healthcare organizations roll out cost-saving automation in critical areas such as health information management (HIM). For example, healthcare organizations are investing in technologies that integrate patient information from disparate systems to create a single patient financial record. Having a patient’s financial information in one place allows organizations to capture lost revenue from unbilled claims, reduce A/R days, improve HIM workflow, and create new efficiencies allowing for reallocation of staff and resources.

Patient access is another area where the modern revenue cycle promotes innovative, cost-saving changes. "It’s important to think about how consumers play into the revenue cycle in order to improve the patient experience, be more efficient, and reduce costs," says Gustin. To that end, sophisticated organizations use technology, analytics, and smarter processes that enable patients to register online, receive up-front cost estimates, pay their bills before getting treatment, and receive streamlined bills that are easy to understand. This improves the patient experience and reduces self-pay collections.

The modern revenue cycle also supports hospitals as they create more efficient payer processes, says Gustin. "There are a lot of great technologies and process improvements that fix errors on the back end of the revenue cycle, but it’s important to eliminate errors and the issues that ultimately cause denial up-front," he adds. "You need a denial prevention solution that ultimately reduces costs for providers and the payer."

The benefits of the modern technology platform

"Advanced technology platforms enable healthcare organizations to be competitive in today’s fee-for-service market, address current pressures, and rise to the next level of modernizing the revenue cycle and supporting innovation," says Gustin.

"Healthcare organizations must have a high-functioning technology platform to interact more effectively with patients and payers," he notes. "The modern revenue cycle is becoming much more efficient using a technology platform that brings intelligence to the process." Some of that intelligence will come through automation and smart technology." Current examples include computer-assisted coding and clinical documentation improvement, both of which are supported by natural language processing and designed to automate and drive results from unstructured data.

"Data that previously required a lot of time, resources, and hands-on labor to evaluate—and in some cases, was too complex to understand—can now be analyzed through a technology that uses automation and looks at both financial and clinical data in ways that weren't previously available," says Gustin. In turn, this improves coding and documentation methods as well as claims processes, such as by reducing denials and speeding up reimbursement.

New staffing models support the transition to value

Finally, having an efficient revenue cycle staffing model is essential as value-based care continues to unfold. The modern revenue cycle includes a staffing plan supported by a common technology platform, centralization, targeted data, and advanced workflow initiatives. For example, with these advances, organizations can shift staff around more quickly based on work volumes, as well as increase productivity and accountability through better metrics and reporting processes. "New staffing models, like the rest of a high-functioning revenue cycle, provide the flexibility, scalability, and standardized approach to support the healthcare organization," says Gustin.

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