Healthcare Revenue Cycle – New Opportunities and Same Old Challenges

The following is a guest blog post by Kurt Wolter, Enterprise Account Executive, and Philip Lewis, Senior Director, Revenue Cycle Consulting at Atos.

Revenue cycle management remains a complex and often fragmented set of critical processes in healthcare organizations.  Billing systems were among the first IT systems introduced in healthcare- well over 40 years ago. 

Like most technologies, these systems only deliver value when the workflows, processes and training are well orchestrated.

The typical challenges around revenue cycle include inaccurate information at registration, incomplete/inaccurate documentation, incorrect coding, lack of resources to perform the volume of work, and challenges finding qualified resources.  These have been further complicated with new or replacement Electronic Health Records (EHR), lack of integration and testing with new or old revenue cycle systems, and the move to ICD-10.

Despite these challenges, some healthcare organizations are finding new opportunities in the current landscape. Although the concept of pushing the responsibility of correcting bill edits to the clinical and registration departments is not new, using the technology embedded in some EHR systems enables better management of this important paradigm shift. These processes include:

  • Automatic generation of alerts and reminders that are sent to specific physicians and clinicians asking them for validation and clarification without the manual intervention of a biller.
  • Clinical department leaders using work queues where they can validate and correct charges that appear inconsistent with the care provided, since they are best trained to evaluate the clinical documentation.
  • Billing errors have gone down drastically as a result of the patient facing departments having a better understanding of their actions and can be proactive in documenting the accounts.
  • Although payer denials have not gone down, being better prepared to appeal the denial by having the documentation readily on hand greatly reduces the traditional efforts of tracking down or creating the needed clinical support.

Adopting a clinically driven revenue cycle mindset allows organizations to gain more value across the continuum of care.  The value encompasses every process from accurate and timely billing to efficiencies across multiple departments and ultimately in clinician engagement and satisfaction.

Recommendations to Healthcare Organizations:

  • Communication and Governance: The communication and governance is key to a successful transition.  Just shifting responsibility without the appropriate training, interaction between departments and monitoring is rarely effective and will only create additional backlogs and confusion.
  • Document the Entire Process: Revenue cycle begins in registration and follows a complex path through multiple administration departments and clinicians. Most organizations have never fully documented the processes and roles necessary for accurate and timely payments.  This is important and difficult work.
  • Ongoing Training and Education: These processes require training on software, processes, regulations, and organization specific best practices. This can’t be a “one-time training”- it must be continuous, timely and valuable.
  • Technology Set Up is Critical: The rules, notifications and overall set up should be done with expertise from the organization (registration, billing, HIM, and clinicians).  The vendor can make recommendations, but they don’t have the knowledge of your internal practices to make these decisions.
  • Engaging Clinicians: The last thing clinicians need is “more to do”, but they are a critical stakeholder in accurate and valuable documentation which leads to accurate billing and reimbursement. Organizations that invest in both the educational and cultural processes do much better at engaging clinicians and gaining their mindshare.

About the Authors:
Kurt Wolter: Enterprise Account Executive at Atos. has more than 25 years of experience working with healthcare organizations across the country, designing, and implementing Revenue Cycle performance improvement processes and systems.

Philip Lewis: Senior Director, Revenue Cycle Consulting at Atos.  Phil has over 25 years of experience in implementing and optimizing Revenue Cycle systems.  One of his main focus has been on engaging non-revenue cycle departments in the process versus blaming them for the downstream errors.

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

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  • You left out the patient – most have NO understanding of their insurance, how it works, coverage and expect the physicians office to know this information. Plus they hold on to multiple insurance cards, most of which are expired which leaves the front desk person to go on a scavenger hunt for the correct information.

  • Truly appreciate the term “clinically driven revenue cycle”. And agree with Cynthia, we should add “patient driven revenue cycle”. Everything from patient financing programs to price transparency and financial counselors are necessary with dramatic increases in the patient-pay portion of healthcare receivables. Great stuff here –keep it coming!

  • That’s a great point Cynthia. There’s a lot that can be done with the patients to improve revenue cycle as well. In fact, that could be an entire article of it’s own.

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