Round Up: How Cost Containment, Denials, and Cybersecurity is Defining Rev Cycle

There are three prevalent issues that defined the first quarter that leaders should know.

As we wrap up the first quarter of 2024, cost containment, denials management, and cybersecurity stand out as key issues revenue cycle leaders should be mindful of going into the remainder of the year.

Cost Containment

Many health systems are toeing the line of financial stability, looking to contain – or cut – costs whenever they can.

OSF HealthCare is doing its best to maintain the financial stability it’s built after the system’s operating margin fell to -3% in 2022.

Kirsten Largent, senior vice president of financial operations, attributed the decrease to workforce disruption. The system’s current stability comes as a result of rebounds in patient volumes, reducing agency costs, negotiating managed care contracts, and strong performance on value-based contracts.

“We use many vendors as extensions of revenue cycle to assist with some of the niche billing requirements,” Rene Woerner-Utley, vice president of patient accounts, previously told HealthLeaders.

“These include, but are not limited to, vendors for workers [compensation] and third-party liability billing, second level clinical denials, low dollar account collection, and coordination of benefits collection, to name a few.”

Denials Management

Denials remain a pressing issue for revenue cycle operations. The best way to push back against payers, some leaders have found, is to stay diligent and in constant communication with them.

Much of the revenue cycle operations for One Grady, Grady Health’s billing subsidiary, are automated to help streamline processes and increase efficiency; with the tools being leveraged alongside staff like medical coders.

“We’re having to be very intentional and strategic about the way in which we handle denials and really dig into how we operationalize our workforce to be able to manage those denials,” Monica Richey, vice president of physician revenue cycle for One Grady, previously told HealthLeaders.

Cybersecurity

The Change Healthcare cyberattack in late February disrupted the revenue cycle operations of a substantial number of providers across the country, causing them to lose over $100 million in revenue a day.

The attack, and others like it, are becoming more frequent and more complex, forcing many organizations to step up their information technology and cybersecurity safeguards.

“We’re in the business of treating patients, so a lot of the time, if you don’t have people that are focused on this type of stuff and know its importance, it gets thrown by the wayside,” Joi Lee, manager of cyber governance, risk, compliance for Moffit Cancer Center, previously told HealthLeaders.

The magnitude of revenue cycle disruption in the aftermath of the Change Healthcare attack has increased the importance of health systems having a business continuity plan in place so they’re able to continue processing claims and payments.