These are the among the questions that 50 of the nation’s top revenue cycle vice presidents share at the annual HealthLeaders Revenue Cycle Exchange.
Revenue cycle leaders can fall into a trap of merely managing problems that pop up. But the danger with a “fix it” approach is that so many of the challenges in revenue cycle are connected.
Are your denials issues related to staff development in registration or billing? If some of your key indicators are not moving in the right direction, then are you sure you are even measuring the right ones?
These are among the questions that 50 of the nation’s top revenue cycle vice presidents share at the annual HealthLeaders Revenue Cycle Exchange, which will be held March 21-23 in Ponte Vedra, Fla.
Some issues always rise to the top of the discussions, among them:
1. Dialing up the intensity on denials
Managing denials is ever-present in revenue cycle, and leaders are finding that communication is the old reliable skill that patches many gaps. Orlando Health, a $3.8 billion not-for-profit organization serving Central Florida, reduced claims denials to monthly rates as low as 1% and averaging 4% annually by involving key players.
A denials management team marshalled support from leaders across the seven-hospital enterprise to introduce workflow measures aiding denials prevention. The group also instructed employees how to minimize or avoid errors. Establishing a multidisciplinary task force of executives and clinical staff to identify prevention efforts also proved beneficial.
The result of these efforts are cleaner claims. "We have many checks and balances for compliance, from our registration all the way through to our billing," says Bridget Walters, corporate director of enterprise patient access.
2. Hidden costs of poor patient financial experience
The increase of high-deductible plans makes engaging patients crucial. Patients are often confused about their coverage, so proactively educating patients about their financial responsibility can help offset incorrect information and improve collections.
Concise statements and easy-pay options have also delivered results. And offering online service—with self-service portals and a chat line for questions about estimates, as well as the ability to pay—can prompt payment and improve patient relationships.
“We used to have separate bills for our hospital side versus our physician side, and recently we put everything on My Health Online, which is our online system,” says Alex Collins, director of revenue integrity at Piedmont Athens (Georgia) Regional, a 360-bed nonprofit hospital in the Piedmont Healthcare system. “Combining it makes it easier for patients.”
3. Finding and keeping motivated revenue staff
Sustaining a high-functioning operation requires a top-performing team, but the challenge lies in hiring, training, and retaining a staff who can give excellent customer service.
“When hiring, we look for customer service skills first, and then teach them the healthcare side of things versus the other way around,” says Jane McKee, executive director of middle revenue cycle and revenue assurance at Piedmont Healthcare, an eight-hospital, not-for-profit health system based in Atlanta.
Building an accomplished workforce requires ongoing training, monitoring performance, and coaching. Also valuable is soliciting people’s ideas about perfecting the process.
To encourage creative thinking, Donella Lubelczyk, RN, director of revenue cycle at Manchester, New Hampshire–based Catholic Medical Center, affiliated with GraniteOne Health System, assigns her revenue cycle committee to develop an improvement project each fiscal year.
“They have a goal and have to present an update monthly, and we hold them accountable,” she says.
4. Targeting improvement where it matters
Fine-tuning revenue cycle operations demands discipline and discernment. Paul Hanna, senior director of revenue cycle operational reporting for Pittsburgh, Pennsylvania–based UPMC, says one department goal is to “reduce the noise” in reporting.
“I think a lot of health systems measure too many things,” Hanna says, “If you're measuring things that you can’t act on, you may be measuring the wrong things.”
At UPMC, much of the analysis comes from reporting about operational details that reflect current activity. Various areas of revenue cycle meet regularly on key performance indicators (KPIs) to spot trends. With KPI data, the team can dissect issues with a process improvement tool like Six Sigma.
50 Revenue Cycle Leaders. The Best Ideas. You can join.
Are you a hospital or medical group revenue cycle leader? Share real ideas and solutions with the nation’s best, March 21-23, Ponte Vedra, Fla.
Revenue cycle leadership often boils down to hitting the right number.
And each decimal point on that number means a new tool or strategy to drive more efficient and involved operations.
Heightened tactics include establishing greater rapport with payers, intensifying ways to reduce denials, shaping a dynamic team, and making it easy for patients to pay their bill.
Two roundtable events in 2017—the 45-executive HealthLeaders Media Revenue Cycle Exchange in Tucson, Arizona, last March, and the smaller-group HealthLeaders Media Revenue Cycle Leadership Exchange in October in Nashville—invited qualified revenue cycle leaders to share tested approaches and gain applicable ideas from their peers.
Successful strategies that materialized from the discussions include the following:
1. Build relationships with payers.
It's painstaking. It takes time. But there is no getting around the need for establishing closer and more regular contact with payers.
The MetroHealth System in Cleveland, Ohio, a 926-bed hospital with 600 physicians, a Level I adult trauma center, a life flight trauma burn unit, and two freestanding emergency departments, focuses on persistent communication and having the right people on the line for meaningful conversation.
"We meet with each of our payers monthly, and include a physician chair or anyone else involved with the appeals process," says Donna Graham, senior director of revenue cycle. "Having clinical-to-clinical has expedited resolving issues that revenue people and managed care people go back and forth about.
"We've also added our utilization review (UR) team, since payers have a UR clinician, so everyone is talking the same language and determines an action plan."
"We hire good customer service people with experience at department stores, restaurants, and other places involving aggravating situations with consumers."
—Donna Graham, senior director of revenue cycle at MetroHealth System in Cleveland, Ohio
UnityPoint Health, an integrated health system in Iowa, Illinois, and Wisconsin with $4 billion in net revenues, is taking a more assertive approach with payer terms.
"We're working to get shared savings," says Renee Rasmussen, vice president of revenue cycle. "We're also issuing termination notices to third parties for things that aren't right such as denials, and holding insurance companies more accountable."
2. Minimize denials through staff performance, improved documentation, and involving clinicians.
"The major source of waste is first-pass denials," says Patrick McDermott, vice president of revenue cycle at Sutter Health, a not-for-profit healthcare system based in Sacramento, California, with 24 hospitals, 5,500 physicians, and an ambulatory network.
"If you submit 1 million claims a year, 8% to 15% of them will get an immediate denial. And if it's not a key performance indicator, then it's a blind spot for someone running the revenue cycle," he says.
McDermott's strategy was to assign his entire team the responsibility of reducing denials and tying it to performance evaluations. His approach brought positive outcomes.
MetroHealth has minimized denials by attaching a summary of key indicators to the top of the medical record chart. Graham says a concise write-up makes it easier for insurers to review the claim. "It also puts the onus on payers to justify why they're denying it," she says.
Critical to refining claims submissions is engaging physicians and case managers.
"We've implemented meetings three days a week with case management, our front-end staff, our finance folks, and our health information management (HIM) team to discuss concurrent denials, which are mostly status change issues," says Donna Ellenburg, director of revenue cycle at Community Health Systems Grandview Medical Center, a 372-bed hospital in Birmingham, Alabama.
3. Make it easy for patients to interact with you about their bill.
Educating patients about their coverage and payment options is key to getting paid.
South Nassau Communities Hospital, a 455-bed, acute care, not-for-profit teaching hospital with multiple ambulatory facilities in Oceanside, New York, deploys financial counselors to meet with patients during their hospital stay.
Their role can be particularly important when a patient's change in status alters payment responsibilities.
"Our counselors are not just bill collectors; they are focused on education," says John Stryska, senior director, access services. "If there are other people in the room, our counselor explains who she is, that her purpose is to talk about their insurance coverage, and if the patient is comfortable having that conversation with others present. If they're not, then she'll return at another time."
"Our counselors are not just bill collectors; they are focused on education."
—John Stryska, senior director, access services at South Nassau Communities Hospital in Oceanside, New York
Providing easy-to-understand statements and online service is another approach to securing payment. More organizations are offering self-service portals and a chat line for questions about estimates, as well as the ability to pay.
"We used to have separate bills for our hospital side versus our physician side, and recently we put everything on My Health Online, which is our online system," says Alex Collins, director of revenue integrity at Piedmont Athens (Georgia) Regional, a 360-bed nonprofit hospital in the Piedmont Healthcare system that includes a Level II trauma center and a Level III neonatal intensive care unit. "Combining it makes it easier for patients."
4. Develop a high-performing team built on customer service skills.
Nothing beats a top-notch business office staff, who are adept at operations, possess content knowledge, and offer excellent people skills.
Building a high-functioning workforce starts with hiring people who are proficient in dealing with others.
MetroHealth observes applicants before offering them a position. "We hire good customer service people with experience at department stores, restaurants, and other places involving aggravating situations with consumers," says Graham.
Establishing a service-focused team also requires ongoing training and staff development.
"We have a revenue cycle education team dedicated to training," says Collins. "The trainers have a learning portal covering all kinds of courses, including customer service. We provide education about the entire revenue cycle, no matter where an employee fits in."
To spark creative thinking among his team, Josh Welch, executive director of revenue cycle at John Muir Health in Walnut Creek, California, which has two acute care hospitals, an inpatient behavioral health center, and 350 employed primary care and specialty physicians, initiated a program called "Revination" in which staff are rewarded for contributing process improvement ideas.
"Employees need to feel like they can suggest an idea and know that it's going to be carried forth and at least vetted, and then involve them in the process," says Welch. "With our Revination initiative, it's constant communication, sharing success stories, and celebrating people's [input], and even hopefully recognizing employees monetarily."
5. Know when to outsource expertise to minimize service and technology gaps.
Many health systems have learned that it's easier and more effective to outsource portions of their revenue cycle services to outside entities who can address specific limitations.
South Nassau Communities Hospital uses an outside vendor for online payment. "Our vendor has set up a portal in which a patient can go online and make their payment, because our IT department doesn't have the staff or technology to achieve that," says Abdool Razack, senior director of revenue cycle. "It's definitely cheaper to do it outside than internally."
"Employees need to feel like they can suggest an idea and know that it's going to be carried forth and at least vetted, and then involve them in the process."
—Josh Welch, executive director of revenue cycle at John Muir Health in Walnut Creek, California
John Muir Health saves on statements using a vendor. "Our statements are better and their call center is more efficient," says Doug Robison, performance improvement leader. "We collaborated on the scripts to provide a cohesive message."
John Muir is also working with a company to do patient advocacy to help patients—such as those with neurological issues or cancer—figure out highly complex bills, says Welch. "For specific populations who have recurring bills, our vendor advises them about what to pay and when, so we hope that will lead to a positive experience for folks who really need it."
Hospital and health system revenue cycle vice presidents and directors will once again meet to review these strategies and new ones at the 2018 HealthLeaders Media Revenue Cycle Exchange, March 21–23 at Ponte Vedra Beach, Florida.
To learn if you qualify for the invitation-only event, please contact Exchange@healthleadersmedia.com.
Planning for a HealthLeaders Media gathering of hospital and health system chief financial officers reveals the weightiest issues on their minds.
Preoccupying the minds of healthcare financial executives are prevailing problems engulfing the industry's business climate: uncertainty about healthcare reform, declining public and private reimbursement, accelerating operating expenses, and access to capital.
This August, 50 healthcare finance leaders will collaborate on fortifying their organizations' fiscal health at the 2017 HealthLeaders CFO Exchange in La Jolla, CA.
In pre-event planning calls, CFO Exchange attendees, representing integrated health systems, academic medical centers, community hospitals, and safety net providers, have mentioned some of the struggles they'd like to know how others are tackling.
During the two-day event, a series of moderated, peer-to-peer roundtables will explore how organizations are addressing the top five issues.
1. Dismantling of the Affordable Care Act
CFOs foresee the negative financial impact a repeal will generate and are interested in knowing how others are preparing for anticipated changes in Medicaid for expansion and non-expansion states.
"More than 50 percent of our payments come from Medicare and Medicaid. And in South Carolina, there is only one Exchange plan for the state and not many alternatives for the rest, so we're concerned there will be a lot of uninsured patients. In our primary market area, the uninsured shifted from five to seven percentage points from 2013 to 2016, and if the ACA goes away, we expect it to shift back."
— Elizabeth Ward, executive vice president and CFO, Tidelands Health, Georgetown, SC
"Depending on what gets changed with the ACA, it could have a huge financial impact on our system over the next five years, up to a billion dollars."
— John Grigson, senior vice president and CFO, Covenant Health/ Providence St. Joseph Health System, Lubbock, TX
2. Enhancing and Supporting Population Health
CFOs are concerned about building the right infrastructure to support population health, including integrating physicians, retooling their workforce, realigning the financial tracking of population health efforts, incorporating behavioral health in primary care, and determining how much payer risk to assume.
Executives expressed their concerns about knowing how and when to invest resources in a relatively uncharted path.
"At the highest level, healthcare reformers and the government are still driving us toward a population health environment, from volume to value. How much infrastructure do you invest in? What capabilities do you need? What is the timing going to be? Because no one knows the speed of this conversion, if you move too fast, then you put your health system at risk; but the same is true if you move too slowly."
— John Grigson
In addition, they are interested in how to bring disparate goals together to align with population health efforts.
"How do you address utilization from the standpoint of a mixed medical staff? We're a community hospital with employed and independent physicians, in which success depends on balancing the wants and needs of employed physicians with the independent community to achieve savings. How do you engage both physician groups in what has to happen in population health—such as access for patients, and measuring and monitoring the continuity of care?"
— Elizabeth Ward
"Population health is really about behavioral health changes, which requires more than getting physicians to influence their patients. I view this in light of Medicare Access and CHIP Reauthorization Act (MACRA) and MIPS (Merit Based Incentive Payment System)—in which specialists need to realize they need to have as much impact on their patients as primary care physicians, or they will lose reimbursement in a big way."
— Garrick Stoldt, CFO, Saint Peter's Healthcare System, New Brunswick, NJ
3. Curtailing Clinician Costs
Optimizing access and productivity to ensure profitability among acquired physician practices, reducing clinical practice variation and cost-per-case, and lowering costs associated with filling in with agency labor due to the nursing shortage are challenges for senior executives.
Organizations will be requesting and sharing strategies for seizing the reigns on clinician expenses.
"From a CFO perspective, the biggest opportunity in cutting costs and eliminating waste is through clinical variation reduction. We can save over $100 million and gain quality and safety just by eliminating variation—but how do we convince our physicians that it makes sense for them and our patients and it is the right thing to do?"
— John Grigson
"We're looking at the downstream revenue of our physician practices and reassessing whether we really need to own certain ones. As a result, we have ended some of the specialists' agreements. Their compensation rates are extremely high, especially when they resist aggregating their services to get economies of scale. We want to stay engaged and aligned, but not necessarily own the practice. Length-of-stay can increase, due to delays in waiting for a specialist consult and then waiting for their report. It's also a source of overutilization due to hospitalists wanting to do a consult for everything.
— Garrick Stoldt
4. Increasing Revenue
Overcoming reimbursement struggles, uncovering innovative ways to cut costs, and ascertaining solutions to avoiding readmission penalties are common goals for CFOs.
"We're still in fee-for-service, so as we move to value, I want to know about different payment arrangements that provide win-win solutions for both providers and employers. Are there new ways to direct contract with employers, so that you're taking commercial payers out of it altogether?"
"So far, I haven't seen value models that are, 'Wow, this works.' I know there's shared savings, but if you're really getting savings, they will eventually dwindle, and the health system will be left trying to figure out how to make it work with decreasing reimbursement. Also, how do we remove costs from the payer level–such as the administrative costs of appeals and getting authorizations--and not just the provider level?"
— Marlene A. Weatherwax, vice president and CFO, Columbus Regional Health, Columbus, IN
"Observation is the front and center issue for us. It's the Two-Midnight Rule and payers denying every admission that is two days or less even in the face of evidence-based medicine. We're writing three-page appeals for short stay admitted patients and winning, but this adds administrative costs. So we're continuing to educate ER physicians, and provide more physician advisors and care coordinators to properly document when a patient should be admitted, rather than putting them in observation. Between observation cases and DRG discharge ones, it's an enormous revenue differential."
— Garrick Stoldt
5. Determining Gaps and Opportunities
Another goal shared by CFOs is the desire to share the most useful data analytics and business intelligence platforms for improving quality-of-care and outcomes.
"Diversifying your revenue stream is always better than cutting costs, so we spend 70 percent of our time seeking how to grow and exploring opportunities in the market. How do we create new revenue streams and look for new opportunities in partnerships, joint ventures and/or acquiring other similar services?"
— John Grigson
"Everyone tends to get caught up in next new technology versus failing to see what's happening around us. Technology is not going to answer some of the issues we're facing, but expertise, and knowledge, and the listening that has to happen when you deal with human beings.
"Networking is the better way--within our organization, but also listening to what challenges that city and county planners and employers have. I tend to pay attention to the 'data' that's surrounding me, mostly the voice of the community, board members, and physicians and nurses who are on the front lines. Through this, we're starting some initiatives, such as patient advocacy meetings and employing some marketing tools to get voice of the customer as well."
In addition to their larger concerns, participants at the invitation-only event will talk about consumerism, direct contracting for healthcare with employers, charting a financial strategy on value-based care, and ideas about what competition will look like in the future.
Changing a healthcare organization's culture, improving its documentation, and involving patients in payment strategies leads to higher margins.
Of the 32 leaders who responded to a pre-event survey, half cited insufficient integration and collaboration between finance and clinical teams as the biggest barrier to revenue cycle improvements. Organizations are addressing this by upgrading outdated and underperforming electronic tools to accurately capture records and complete revenue cycle activities. But state-of-the-art technology demands a sizeable investment and skills to manage its complex implementation.
Higher deductibles, antiquated technology, information gaps, lax documentation, and increasing denials are top issues facing financial executives. More than three dozen healthcare leaders will discuss these challenges, as well as strategies for maximizing reimbursement, during roundtable discussions at the first HealthLeaders Media Revenue Cycle Exchange this week.
Marrying Financial and Clinical Worlds
Catholic Medical Center in Manchester, NH, is overcoming the hurdle of aged technology. It operates numerous diverse systems, acquired over the past 30-plus years; this impedes precise data collection, and the organization plans to move to a single IT platform in the near future.
"Not all of our systems talk to each other," says Donella Lubelczyk, RN, BSN, ACM, director of revenue cycle at Catholic Medical Center. "This requires a lot of manual effort—making it difficult to pull data and measure our successes, as well as [handle] denials and appeals."
Lubelczyk's clinical background, however, gives her insight into how to mesh the financial side with the clinical. To increase efficiencies, Lubelczyk tasks her team to set measurable goals for improvements and submit monthly reports documenting process improvement. To encourage prompt charge transactions, for example, departments are working with the revenue cycle team to determine what an acceptable number of late charges should be and to reduce the frequency of such charges.
Simply relying on advanced technology is not a cure-all, according to Tammy Thomlison, chief revenue cycle officer for University of Mississippi Medical Center in Jackson, MI, who finds that transforming an organization's culture is a key driver of change.
"As an organization, we financially commit to implementing systems to achieve what we want to accomplish. However, systems are only as good as how we balance our people and operations with that technology," she says, explaining that success largely depends on getting physicians, staff, and patients to alter ingrained behaviors.
For example, to maximize Medicare reimbursement, it's crucial for physicians to write appropriate orders. When physicians balk at changing how they typically write an order, Thomlison's team pulls denial data to show how reimbursement depends on the order being written a certain way.
"We have created multiple-layer reports that sort denials by physician, service line, and patient level to illustrate to physicians the revenue lost because we can't bill it [their way] and receive payment," she says.
Even extensive lengths-of-stay at the medical center were largely due to cultural behavior. "Upon examining our top 25 highest and lowest diagnosis-related group codes (DRGs), the main culprit was an inefficient discharge process," Thomlison explains.
"We coordinated with physicians and case management to begin the discharge thought process when the patient is admitted. An example would be to get a patient's labs completed and results back before discharge, instead of waiting until 10 a.m. their day of departure. And we established a 'discharge lounge' where a patient can wait for a ride home, but would no longer be listed as a patient."
When a patient requests a service that is not covered for a particular diagnosis, physicians are informed that their patient will be responsible for payment. "Our financial counselors consult with the physician and discuss the financial impact to the organization should the patient proceed with the test and not pay," says Thomlison. "Patients are also asked to sign a form acknowledging their agreement to pay."
Training financial staff to effectively communicate with clinicians is another proven strategy for optimizing reimbursement.
"The business office used to be able to handle payer problems [straightforwardly], such as capturing proper ID and a patient's insurance eligibility," says Rick Scherich, corporate controller for Ohio Valley Health Systems, a 289-bed system located in Martins Ferry, OH, and comprised of Ohio Valley Medical Center and East Ohio Regional Hospital. "Now, payers are requesting certain documentation, such as tests proving medical necessity."
Scherich is helping business office personnel acquire expertise in probing clinicians about why a certain test or procedure was ordered. "One of the barriers is that clinicians don't like their judgment being questioned," he adds.
Getting to 'Yes;' Avoiding 'No'
To improve collections and reduce denials, 30 respondents responded that performing up-front insurance verifications and pre-authorizations, followed by conducting point-of-service collections with scripts for frontline staff, are powerful measures for capturing every dollar.
A safety-net hospital in Kansas City, MO, Truman Medical Centers has partnered with a third-party vendor that specializes in Medicaid, Social Security disability insurance, and other programs for complex patients to determine coverage eligibility. Historically, more than 30% of its patients have been uninsured.
The company found that some of these uninsured patients actually were eligible for coverage, and as a result, Truman lowered its share of uninsured patients from 36% to 24% over the course of a year.
"For the last few years, we've focused on point-of-service collections and changing the culture from being known for 'free care' to one in which patients feel they have some financial responsibility," says Doug Brandt, associate chief financial officer at
Truman. "We've become aggressive in getting individuals qualified for coverage.
"Even for the poorest patients who qualify for full financial assistance, we ask for a $5 copay, so they make an effort to pay something," says Brandt. "For those who qualify for healthcare insurance exchanges, we ask for a $25 copay. This [initiative] has added $4,000 per week and has helped us pay the bills."
Catholic Medical Center has taken the tactic of establishing a patient responsibility subcommittee, which meets regularly to review point-of-service collections. The organization has also developed scripts to help staff who are uncomfortable with talking to patients about copays and outstanding payments.
Uncovering Obstacles with Technology
IT-enabled activities also aid in reducing denials. Thirteen surveyed executives said technology helps identify areas that generate a higher-than-average denial rate.
To capture missing documentation and errors and track denials, University of Mississippi Medical Center loaded 2,500-plus payer remittance advice and remark codes into its system to track denials and billing edits as they go through the billing cycle. The system alerts the billing department to investigate a suspicious claim before it's submitted for payment. Thomlison also mapped these remittance codes to clinical and technical denials, enabling the organization to route specific accounts to the appropriate party to address. Within the first year, denials dropped from 13% to 8%, with a future goal of meeting industry standards of less than 5%.
"Prior to mapping, these claims were hanging out in our system and not assigned for immediate follow-up," she says.
After identifying its top 20 denials and the responsible party or department, Truman tasks teams to conduct problem-solving analysis and implement process improvements for each one—such as refined coding or better utilization management—which has saved millions of dollars.
Catholic Medical Center accesses denial management software to drill down to its top five denials and corresponding areas. The revenue cycle group devises solutions and generates a "lost revenue action log"—applying an action item to reduce denials.
"Many payers now require preauthorization for things that previously didn't, which isn't always known until we receive a denial," Lubelczyk says. She employs a software program to alert the responsible party that a procedure needs preauthorization or that a payment needs a report attached to the bill.
Scherich, meanwhile, teaches his team how to dive deep into medical records to uncover evidence to reverse a denial.
Partnering with Patients
Almost all survey respondents are developing a customer-friendly staff and culture in the revenue cycle team to engage patients as financial partners. A majority (25 of 32) also employ financial counselors to help with collections.
Ohio Valley Medical Center helps make the payment process easier and friendlier by educating patients about their insurance coverage "so they can make informed decisions and will understand that they will receive a bill," says Scherich. The hospital also instituted an interest-free loan program to help with payment plans.
With a payer mix of mostly Medicaid, followed by Medicare, commercial, and managed care, University of Mississippi Medical Center provides health benefit coordinators (HBC) and financial counselors who know state and federal rules and regulations.
"Individuals who are not insured or are underinsured meet with our HBC team, who works with patients to qualify them for government-assisted programs, the healthcare exchange programs, and the Mississippi division of Medicaid's Hospital Presumptive Eligibility program," says Thomlison.
Providing financial counseling and trying to obtain up-front payment are among the strategies that Catholic Medical Center employs.
"We also offer a prompt-pay discount, in which we notify patients about their balance. If they pay right away, then we give them a 35% discount," Lubelczyk says. "Getting a portion of the payment immediately is preferred over chasing it forever."
In addition to answering survey questions, respondents were invited to comment on revenue cycle software and clinical documentation.
I wish our revenue cycle software tools would …
[Have] automation for functions to make the job easier for the end user. Provide more opportunities for grouping accounts going through similar issues, work listing, etc.
More seamlessly integrate with one another. There are too many disparate systems and it is challenging to get the data to interface across all systems.
Provide true denial information by line item, in order to more efficiently provide reports back to clinical areas.
Provide real-time meaningful data. Easily combine clinical and financial data that enables revenue cycle to take action on variations.
Provide cost data to better assess charges versus reimbursement and establish better data for patients who are uninsured.
Be more robust so we could have fewer bolt-ons and be able to know the status of an account at any moment.
For clinical documentation, I wish our physicians would ...
Understand the difference between the volume of what they document versus the quality of what they document.
Know the rules relating to documentation that would minimize denials and maximize reimbursement.
More universally understand the impact that their diagnosis selection has on mortality rates.
Provide constructive feedback on how we can improve our CDI program and appropriately respond to (and learn from) queries and educational sessions.
Contact the CDI specialist real-time when questions arise.