The following is a guest blog post by Brad Josephson is the Director of Marketing and Communications at PMMC.
For healthcare providers struggling to accurately collect reimbursement, developing a revenue strategy based off a foundation of accuracy is the most efficient way to ensure revenue integrity throughout the revenue cycle.
Currently, many hospitals operate under multiple systems running for their different departments within the organization. This type of internal structure can threaten the accuracy of the analytics because data is forced to come into multiple systems, increasing the chances that the data will be misrepresented.
By maintaining revenue integrity, not only does it give hospitals assurance that the data they’ve collected is current and accurate, but it also provides invaluable leverage with the payer when it comes time to (re)negotiating payer contracts.
Let’s begin by starting from the ground up…
Here are the 3 steps needed for maintaining revenue integrity:
- Creating a foundation backed by accurate analytics
- Breaking down the departmental siloes
- Preparing ahead of time for consumerism and price transparency
Accuracy Drives Meaningful Analytics
The first step toward maintaining revenue integrity is to assess whether your data is accurate. We know that accurate data drives meaningful analytics, essentially functioning as the engine of the revenue cycle.
And what happens when you stop taking care of the engine regularly and it no longer works properly? It not only costs you a lot of money to repair the engine, but you may also have to pay for other parts of the car that were damaged by the engine failure.
What if, however, you were able to visualize pie charts and bar graphs on your car’s dashboard that showed the current health of the engine to inform you when it requires a maintenance check?
You would be better informed about the current state of your engine and have a greater urgency to get the car repaired.
This same principle applies to healthcare organizations looking to increase the accuracy of their data to drive meaningful analytics. While some organizations struggle to draw valuable insight from pieces of raw data, data visualization tools are more efficient because it allows the user to see a complete dashboard with a drill-down capability to gain a deeper and clearer understanding of the implications of their data analytics.
Data visualization allows healthcare providers to quickly identify meaningful trends. Here are the 4 key benefits of implementing data visualization:
- Easily grasp more information
- Discover relationships and patterns
- Identify emerging trends faster
- Directly interact with data
Figure 1: Payer Dashboard
Removing Departmental Siloes
While data visualization does generate helpful insight into current and future trends, it begins with storing the data in one integrated system so that different departments can easily communicate regarding the data.
System integration is crucial to maintaining revenue integrity because it dramatically lowers the likelihood of data errors, missed reimbursement, and isolated decisions that don’t look at the full revenue picture. Here is a list of other issues associated with organizations running revenue siloes:
- No consistent accuracy metrics driving performance and revenue.
- Different data sources and systems drive independent and isolated decisions without known impact on the rest of the revenue cycle.
- Departments cannot leverage analytics and insight into contract and payer performance.
In the spirit of the recent international World Cup games, think of revenue siloes like playing for a professional soccer team.
Similar to the structure of a hospital’s revenue team, soccer teams are large organizations that need to be able to clearly communicate with each other quickly in order to make calls on-the-spot. These quick decisions can be the difference in turning the ball over to the other team or scoring a goal in the final minutes so it’s crucial that everyone knows their role on the team.
If other players don’t understand the plays that are being called, however, then mistakes will be made that could cost them the game. Each player on the team needs to study the same playbook so they stay on the same page and decrease the chances that a costly mistake will be made.
A hospital’s Managed Care department works in a similar way. If Managed Care is preparing to renegotiate payer contracts, they need to fully understand and have insight into underpayment and denial trends across multiple payers.
Preparing Now for Consumerism and Price Transparency
Now that we know the reimbursement rate is accurate, how do we communicate an accurate price to patients in order to encourage upfront payment?
Studies have shown that by increasing accuracy in pricing estimates, it increases the likelihood that patients pay upfront, which can help your organization lower bad debt.
In an effort to migrate to a more patient-centric approach, these accurate online estimates also enable hospitals to address the patient’s fear of the unknown with healthcare of ‘how much is this procedure going to cost?’ By giving the patient more control over their financial responsibility, hospitals can become a leader in pricing transparency for their entire community while expanding on their market share.
At the end of the day, what this all comes down to is maintaining accuracy to help drive your revenue strategy. By integrating all data into a single system, the hospital is positioned to identify trends more quickly while increasing the accuracy of their patient estimates, ultimately driving your revenue strategy to new heights.
With many healthcare organizations still making the transition away from the traditional fee-for-service model, now is the time to prepare for consumerism and value-based care. Take some time to evaluate where your organization currently stands in the local market as well as any pricing adjustments that need to be made.
About Brad Josephson
Brad Josephson is the Director of Marketing and Communications at PMMC, a provider of revenue cycle software and contact management services for healthcare providers. Brad received a Bachelor of Arts, Public Relations and Marketing Degree from Drake University. He has worked at PMMC for over three years and has a deep knowledge of hospital revenue cycle management tools which improves the financial performance of healthcare organizations.