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Analysis

Physicians Frustrating the Revenue Cycle? Try These 3 Fixes.

By Alexandra Wilson Pecci  
   September 24, 2019

Bellin Health System shares three key strategies to get physicians onboard with the revenue cycle.

Earlier this year, Kayne Coleman, MBA, system director of revenue cycle for Bellin Health System in Green Bay, Wisconsin, got what she called a pleasant surprise: A request for the revenue cycle department to return as a presenter at the medical executive committee's (MEC) upcoming meeting.

"What universe am I living in when our med exec committee is asking to have revenue cycle on the agenda to do a follow up?" Coleman laughs.

That universe is one in which Bellin Health's revenue cycle leaders have made an ongoing and concerted effort to reach out to, engage, and teach physicians about revenue cycle, from prior authorizations to medical necessity.

"Providers want to take care of patients, and while they understand the need to get paid for that, often the things that revenue cycle says [the physicians need to do] feels harassing, annoying, and maybe even counterproductive to patient care," she says.

Therefore, Bellin Health has been working on creating a culture where the revenue cycle and physician teams are regularly working on shared goals that unite physician practice with the business side of healthcare.

Part of doing that is by leadership establishing a structure that encourages learning, communication, and teamwork among the professionals. Although Coleman doesn't have financial data to share about the program's success, she's encouraged by the increased attention from physicians.

"There's not monetary bottom line results that I can point to," she says. "But the fact that [the MEC is] requesting follow up demonstrates a shift in the engagement piece."

Here are three elements of Bellin's engagement efforts between the revenue cycle and physicians.

1. Develop revenue cycle liaisons
 

Bellin has been developing clinical business operation employees into revenue cycle subject matter experts (SME).

"The SMEs exist at the service line–level and engage with revenue cycle leaders to drive improvement," Coleman says. "The SME acts as a liaison between clinical operations and revenue cycle."

She says the SMEs educated the physicians about finance and revenue cycle foundations, explaining the basics of income statements and balance sheets, so they "could understand AR, allowances, gross revenue versus net revenue, denials, denial write-offs, etc."

In addition, the SMEs can "translate" revenue cycle needs to clinicians.

"Coders speak in codes; providers know diagnoses. We were not translating," Coleman says. "And we were not thinking about who our audience was and presenting in a way that they understood."

Bellin has also created service line–level scorecards that highlight and evaluate high-level revenue cycle key performance indicators (KPI) that clinical operations can improve, like prior authorizations, medical necessity, and credentialing, along with traditional revenue cycle KPIs, like days in AR and aged AR.

From there, the SMEs can look at the scorecards from a clinical operations perspective and ask, "What things in our daily work are having impact?" Coleman says.

2. Understand—and address—physician challenges
 

When the revenue cycle team wanted to reduce the use of obesity-related unspecified codes (which can lead to denials), they started by meeting with a small group of primary care physicians.

One of the providers mentioned that when typing the word "obesity" into the electronic record, they were presented with hundreds of different options.

"It's overwhelming, and who's going to be able to figure out which of the 700 [codes the doctors are] supposed to select?" Coleman says. "One of the first things [to address] was getting that 700 to a manageable number."

3. Get face time
 

Whether it's getting revenue cycle topics on clinical meeting agendas or meeting regularly with SMEs, face-to-face discussions between clinician and revenue cycle teams are important.

The unspecified obesity coding anecdote illustrates why Bellin groups meeting together is important. Coleman says had revenue cycle and physicians not been meeting, talking about the issue, and asking questions, it would have been easy for the revenue cycle to simply become frustrated with the physicians, wondering, "They know it's important; why aren't they doing it?"

"If you sit down with [physicians] and actually see what they're seeing, it becomes much clearer what the problem is, what the barrier is," she says.

By continuing that kind of dialogue, open communication, and ongoing education, Coleman says Bellin will continue to strengthen the connection between clinicians and the revenue cycle.

"It's certainly not a flipping-the-switch kind of fix," she says. "It's building the relationship."

For more insight from Coleman and other health system executives about engaging physicians in the revenue cycle, download our free HealthLeaders Revenue Cycle Exchange Insights Report.

Topics like this are discussed at the HealthLeaders Revenue Cycle Exchange. Sharing of best practices and solutions and peer networking are advantages participants gain through Exchange attendance. The Revenue Cycle Exchange is one of six healthcare thought-leadership and networking events that HealthLeaders holds annually. While the events are invitation-only, qualified healthcare executives will be considered. To inquire about the HealthLeaders Exchange program, email us at exchange@healthleadersmedia.com.

 

Alexandra Wilson Pecci is an editor for HealthLeaders.

Photo credit: Kayne Coleman, system director of revenue cycle for Bellin Health System (Photo: David Hartig)


KEY TAKEAWAYS

Develop liaisons to create an educational bridge between the revenue cycle and clinical operations.

Work at the service line–level to evaluate KPIs that clinicians can improve.

Listen to physician challenges to identify—and implement—necessary fixes.

Revenue cycle leaders and physicians should meet regularly to build relationships and develop trust.


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