Cash is Queen Says RCM Experts

Revenue provides stability and flexibility to healthcare organizations. Both are extremely valuable as patient volumes remain below pre-pandemic levels. The healthcare staffing crisis is also putting severe margin pressure on organizations. To address this challenge, organizations are turning to technology and partnering with specialized vendors to improve their revenue cycle processes.

Healthcare IT Today recently sat down with two experts in revenue cycle management (RCM) to discuss how adopting technology and properly motivating people can make a big difference:

  • Jess Stover, Senior Vice President of Revenue Cycle Management Division at SimiTree, a provider of financial, clinical and operational consulting, including outsourced billing; and
  • Derek Shaw, President at Invicta Health Solutions, a company that combines technology and people power to help healthcare providers improve operational and financial performance

Cash is Queen

“It’s always about cash,” stated Stover. “Improving cash and improving the bottom line is the goal. We become an extension of our clients to get that cash in so that our healthcare clients can continue doing what they do best – providing optimal care. I like to say cash is queen.”

Cash gives healthcare organizations the stability to weather challenging times and make the necessary investments in technology and people to continue delivering quality care.

“Jess is spot on, cash is queen,” echoed Shaw. “The queen is the most flexible and dangerous object on a chess board. When we’re looking at revenue cycle, we’re looking at it from a cash and KPI perspective.”

To keep revenue processes running smoothly, healthcare providers and companies like SimiTree and Invicta are adopting new technologies.

Adopting Technology

“For Invicta, we are dedicated to automating processes,” explained Shaw. “Whether it’s real-time claims status being available for over a thousand payers nationwide or eligibility and benefits checks, coupling it with our RPA [robotic process automation] technology…that’s really where opportunities begin to shine.”

The upside of adopting technology for RCM can be significant:

  • A drop in DSO (days sales outstanding)
  • Few days in accounts receivable
  • An increase in the clean claim rate
  • A decrease in days in total discharged not final billed
  • A lower cost to collect

“We have developed automation and have worked with team members and other vendors to create automation and scripts with the use of robots and AI,” said Stover. “Any repeatable process can be automated. I think that is our biggest opportunity – to continue to work through all these automations and take mundane tasks out of the hands of our team members to make them more strategic.”

One technology in particular is proving to be very effective for RCM improvement – data analytics.

Big Data

“Data has been compiling for years and sitting cold and dark for all of that time,” stated Shaw. “There is so much data at our disposal: CPT data, billing data, patient data, and demographic data. From Invicta’s standpoint, we are currently gathering data on hundreds of millions of patients and we are working with our team to put together a data scientist and analytics department. That’s where our organization is headed so that we can assist hospitals in not what’s happening yesterday or what’s happening today, but where are we going tomorrow?”

Invicta is planning to use data to help identify potential opportunities for process improvement and revenue efficiency. To achieve this, Invicta has partnered with Inovalon, makers of a platform that delivers real-time data and analytics.

“Data no longer sits cold and dark with Inovalon,” said Michael Quinn, VP of Strategic Partner Sales at Inovalon. “We are passionate and dedicated to working with healthcare partners, RCM leaders and clinicians to put our extensive pool of primary-sourced data to meaningful use. We believe the data should be easily accessible and actionable for providers to keep patient care at the core of all they do.”

Good timing

Both Stover and Shaw pointed to the unprecedented need to adopt technology for revenue cycle given the current challenges facing healthcare. With patient volumes still below pre-pandemic levels and with fewer administrative staff to support the revenue cycle process, technology is needed to help healthcare organizations do more with less.

Being more revenue cycle efficient will not only help organization right now, it will position them well for the future.

Watch the full interview with Jess Stover from SimiTree and Derek Shaw from Invicta Health Solutions to learn:

  • How Invicta’s unique internal gamification motivates staff with XP and non-monetary rewards
  • Why communication from leaders remains key to RCM improvement
  • How executives can make work-from-home for RCM staff work

Learn more about SimiTree: https://simitreehc.com/

Learn more about Invicta Health Solutions: https://www.invictahs.com/

Learn more about Inovalon: https://www.inovalon.com/

Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.

And for an exclusive look at our top stories, subscribe to our newsletter.

Inovalon is a proud sponsor of Healthcare Scene.

Transcript

[00:00:09] Colin Hung: Hi and welcome to Healthcare IT Today, where we explore the latest healthcare technology trends and discover valuable insights in health IT. I’m Colin Hung and today we’re going to be talking about a very interesting topic: revenue cycle.

In the past three years, there has been an increase in the adoption of technology to support the management of revenue cycle processes and healthcare providers are leveraging technology to help improve processes, maximize staff efficiencies and scale their organizations. Joining me today is a group of experts who will be sharing their insights with us on the before and after affects of technology adoption on the revenue process.

Hello everyone, and welcome to the program. Jess, if you could introduce yourself and tell us a little bit about the company you represent.

[00:00:59] Jess Stover: Sure. Thanks Colln. I’m Jess Stover. I’m a Senior VP and Principal at SimiTree. SimiTree offers a full suite of consulting and tech enabled outsourcing services. I oversee our revenue cycle management outsourcing team.

[00:01:18] Colin Hung: And Derek?

[00:01:21] Derek Shaw: Hi, I’m Derek Shaw. I’m the President of Invicta Health Solutions. Invicta is a fun shop. It is a full service revenue cycle company, much like what Jess was mentioning. We cover everything from patient Medicaid enrollment all the way through the revenue cycle and the recovery process. We are also a technology development company, which is why I’m so excited to be talking to everybody today. Developing on the IT front, especially in RCM, is a lot of fun right now.

[00:01:51] Colin Hung: So Derek, I have to say, not a lot of people use those two words in a sentence: fun and revenue cycle.

[00:01:55] Derek Shaw: Isn’t that a shame?

[00:01:59] Colin Hung: But I have to say, for all of us in healthcare and who live in this space or touch the space, it is actually a lot of fun. There’s a lot of interesting things happening right now. So let’s dive in with the both of you and explore that. Right off the bat, let me ask you, Jess…why is improving revenue cycle so important right now?

[00:02:23] Jess Stover: It’s always about cash – improving cash and improving the bottom line is the goal. We want to be able to be in a position where our clients are succeeding. They’re out there and doing what they do best, which is seeing patients and providing the best optimal quality of care. Our team then come falls in the backside.

We become an extension of our clients and whether it’s in back office functions such as revenue cycle or even up front in the revenue cycle from intake to referral management.

I like say cash is queen. I know there is an impression out there that cash is king. We’re going to change that up today and say cash is queen. Ultimately that’s the goal – let’s get that cash in so that our clients can continue to provide optimal care

[00:03:19] Colin Hung: Derek, what’s your thought on the importance of revenue cycle?

[00:03:24] Derek Shaw: There’s no question that Jess is spot on. Cash is queen. I love that the queen is the most flexible and dangerous object on a chess board. So I fully understand, I love that.

For me Colin, I’ve been in the industry for 20 plus years. When I started, I had a lot more hair. I was six foot four and I’m now five nine. My goal and Invictus’ goal has always been to make life easier. Hopefully I can save some people some hair in their future as RCM executives.

When we’re looking at revenue cycle, we’re looking at it of course, from a cash and a KPI perspective, but we’re also trying to look at it with fresh eyes at Invicta. Where is employee engagement today in the RCM world? Where is hospital pain points in the RCM world? And that all flows down to cash, but sometimes you have to get to the root of the problem – what is it that’s happening and how can we help? There’s a Rubik’s Cube at every hospital that needs to be needs to be corrected. So we’re always fun to get engaged with our clients at a grassroots level.

[00:04:39] Colin Hung: And the revenue cycle process is quite complex, right? I mean, there’s all these rules, guidelines, but also with the increase in patient pay, that has really added a new wrinkle to what was already a complex process. Is that right?

[00:04:54] Jess Stover: Yeah absolutely Colin. It’s ever changing and we kind of joke around at SimiTree that that’s the main reason why we’re in business and we continue to stay in business. We have the knowledge, the expertise, and you have to constantly continue to adapt.

We want to be able to see the payment reimbursement changes and regulation changes and stay ahead of that and figure it out for our clients – what does this mean? In some instances, it means, better outcomes, keep doing what you’re doing, but in most situations something needs to change, a process needs to change and it’s coupled with technology too.

There has to be technology in order to stay ahead of the curve and interpret those regulations and be able to utilize that to your best interest and to your operation.

[00:05:57] Colin Hung: What do you have to say, Derek? Do you think it’s gotten more complex? Am I right about that? Or is it getting easier?

[00:06:01] Derek Shaw: Well, considering I started with a, with a steno pad and a number two pencil. Yeah. It’s definitely got complex in this world. To that end, just think about it…20 years ago, I remember a world prior to HIPAA. I remember things being very manual and in processes. And now look at us.

We have RPA in full form. We have 837s, 835s, electronic transmissions, communication between payers and hospitals. Anybody who says this industry isn’t fun, I can tell you it doesn’t have an IT background. We are crossing through a barrier in healthcare that has been a long time coming. It is a lot of fun to be at the forefront of that, but it is more fun to assist clients in hospitals who to Jess’s point change is a tough word historically. And so to be a proponent and a champion of change is, a pleasure and an honor right now,

[00:07:08] Colin Hung: So Derek, since you brought up the word technology. It is obviously a key part nowadays of the revenue cycle process. Can you share with us some of the ways in which you have helped your clients improve RCM, including technologies that you’ve had to adopt or build and any process changes that you’ve had to make?

[00:07:32] Derek Shaw: Sure. At Invicta, like I said, we’re a full service organization, but specifically zooming in on the tech side… When I originally began in the industry, if you wanted a claim status from Blue Cross, you needed to buckle yourself up, sit down and use the telephone. You’re going to wait 20 minutes on hold.

Thank you for laughing. Jessica sounds like you’ve been at that desk.

For Invicta we are dedicated to automating all of those processes. So whether it’s real-time claims status being available for over a thousand payers nationwide or eligibility and benefits checks…taking that basic blocking and tackling of the revenue cycle process and automating it, coupling it with our RPA technology. That’s really where opportunities begin to shine and you get to see some real differences in your frontline staff’s demeanor.

The other area, Colin, that I wanted to mention when it comes to IT, because I feel like it people in healthcare, miss this part, it is pivotal for operators… there seems to be this gap between the IT team and the operations team. They’re constantly banging heads.

Thanks for laughing but you know a big part of what makes Invicta, Invicta is our crew. I have an amazing crew, an amazing staff. Invicta is blessed with the people who work here. But we also work really hard every day internally on a comprehensive gamification platform that tracks everything our team does, rewards them, gives them titles. Right now we’re working on some fun stuff that I’ll mention later in the interview. Gamification, employee engagement, especially after COVID, there’s nothing more important to us right now than keeping an engaged and excited staff in RCM.

[00:09:33] Colin Hung: And Jess, what about you? What are some of the ways you have improved or helped your clients improve their RCM processes?

[00:09:41] Jess Stover: I agree with what Derek’s sentiments are, especially in the position of making sure that IT and technology is interwoven in lock step with RCM. That’s very much the case at SimiTree. I feel like we have our IT team pretty much in lockdown mode. We don’t like to share them with other solutions. No, I’m kidding…but it needs to be that way and set up that way because we have a roadmap that is aggressive and it’s absolutely obtainable because, and only because of technology. We have developed automation and have worked with team members and other vendors to create automation and scripts with the use of robots and AI. That allows our team to remove more of the transactional nature of the work – hitting the button, does that have to be a person or can that be a robot?

What we have found is any repeatable process can be automated. I think that is our biggest opportunity at SimiTree – to continue to work through all these automations and take these mundane tasks out of the hands of our team members to make them more strategic.

I laughed when Derek said about picking up the phone and calling Blue Cross because yeah, that’s a real thing. Even in today’s world, it’s not 20 years ago, it’s still a thing.

There’s so many opportunities to partner with all different aspects. Whether it’s clients or clearing houses, the EMR technology and the workflows that are available there. Some web portals are better than others, but trying to leverage some of those key pieces before you do have to pick up the phone. There’s always going to be a need for people in this industry. There has to be, but if you can leverage technology to make their jobs more efficient and effective, then that’s the golden ticket.

That’s exactly what we’re doing at SimiTree. Every single day we have a really, really complex growth plan for that, but I think with technology, we can absolutely get there.

[00:12:24] Derek Shaw: I love what Jess mentioned about keystrokes and button mashing. One of my favorite things to tell new hires at Invicta is – where you came from they may have been measuring in FTEs, they might have been measuring in hours when it comes to efficiency. We measure in keystrokes. So if you’re not used to that, buckle up because you’re going to get used to it pretty quickly.

So it’s a fun place Jess you are right. Efficiency is so very important.

[00:12:55] Colin Hung: Well, I like how both of you have mentioned that technology is helping to enable staff now. I think before the pandemic, some of these technologies, like you mentioned, like AI were seen as the enemy – potentially taking away jobs. But given what’s happened since the start of COVID and the staffing crisis that we find ourselves in, anything we can do to reduce the burden on the people we have left, because we’re probably down a few people and they’re probably doing the work of four, like a team of two is doing the work of four… so anything we can do to eliminate some of these parts of their jobs so they can focus on other things…it’s probably going to be pretty welcomed at this point.

[00:13:38] Jess Stover: Yeah, it is. I think it’s worth just noting too the fear of losing your job…it’s important to make the distinction and good communication at the leadership level.

And I’m sure that they’re seeing this too, you have to still promote the people. We can’t afford to lose our people. It sounds like Invicta, you have great staff, which you absolutely need. We’re in the exact same boat at SimiTree. My team is fantastic and there is a place and a space for people and technology to work together to advance this.

I don’t see how we would do without one or the other. So I think it’s really, really important comment to make as well.

[00:14:28] Colin Hung: So, let me ask you Derek, what has been the impact of these changes and improvements that you’ve made to the revenue cycle?

[00:14:38] Derek Shaw: From the RPA and the solutions I was mentioning earlier, obviously it goes directly to our clients top line and bottom line.

Just like Jess was mentioning before, we’re constantly focused on the KPIs that matter to our clients. When it comes to internal – keeping employees engaged, sharing that information with our clients to help them keep their employees engaged. You cannot measure the benefits of having engaged employees at this point in time. Especially, in my opinion, being post COVID you have a lot of members of teams, both at the hospital level and at the vendor level who are not used to working from home. They’re used to working in an office space and having that cultural connection to the people around them.

The onus is on executives to make sure that culture, with the help of IT and infrastructure, that culture needs to spread to everyone, regardless of if they’re sitting at home with their dog barking behind them when they’re on a meeting with a client or they’re sitting in one of our offices or in one of our hospitals. That culture needs to permeate through.

You cannot do that without the help of IT and a full buy-in from both the executive level and the frontline level. Those are the major changes. We’re always focused on our client’s KPIs, but to be able to do that and raise the tide with a staff, that’s having fun, doing what they do every day. I can’t ask for more than that.

[00:16:23] Colin Hung: Jess, what about you? What have been some of the impacts and the benefits of some of the changes and improvements that you’ve been making.

[00:16:29] Jess Stover: I think it definitely goes to what they’re saying about you can’t measure the employees engagement, but I think it goes beyond it too. I think some of the impacts we’ve seen is just the improvement with our customer experience and taking it out of our client’s hands to say: “we’ve got this, we can handle this, we’ve got the infrastructure in place”. A lot of times our clients say: we had a really awesome biller, he or she has been with us for 20 plus years in the seat and oh my gosh, they’re looking to retire. We’ve had that a lot.

And so it’s working on a transition plan – making our clients feel really comfortable with what that process looks like. Almost adopting what, again we’re the extension of our clients in that billing and collections function, so it’s really just honoring what their mission is, what their processes and operations are and really just working to improve those collections.

We’ve seen a drop in DSO’s for our clients. We have seen improvements with our basic RCM KPIs – drawing down and decreasing that AR over 90 days is huge. A lot of times we’ll inherit a huge receivable and we’ll work to find pockets of collectability and try to really tap into that technology and say okay, let’s do that. To Derek’s point, let’s do that automated claim status thing and really just utilize our team to work on payer projects and with the insurance companies and develop those relationships that are needed from a human aspect and then remove the rest of these transactional tasks that we can get the robots to do.

I think it’s employee engagement and getting our team to really be more strategic and coupled with the fact that our clients are seeing those results and benefiting from that as well.

[00:18:54] Colin Hung: If we get together or when we get together a year from now and talk about, RCM what are some of the things that we’ll be chatting about? What are some of the improvements or some of the technologies that you see will be top of mind in 12 months? Derek, we’ll start with you.

[00:19:18] Derek Shaw: Sure. So where is RCM headed? My answer to that is twofold.

The most important is big data. Data has been compiling for years and sitting cold and dark for all of that time. No one has been able to tap it. No one has had the computing power to tap it. Again, this is an exciting time Colin. Anybody that tells you otherwise isn’t at the edge.

There is so much data at our disposal. There’s so many transactions. CPT data. Billing based data. Patient based data. Demographic based data. Just look at COVID wouldn’t you have loved to see a data oriented response rate for who’s admitting to an ED in a geographic area with COVID symptoms. It took us way too long to get to that point. That should have been at our fingertips.

I know from Invicta’s standpoint, a year from now, we are currently gathering data on hundreds of millions of patients and we are working with our team to put together a crack data scientist and analytics department. That’s where our organization is headed so that we can assist hospitals in not what’s happening yesterday or what’s happening today, but where are we going tomorrow? And are you armed with what you need to survive in that world?

[00:20:48] Colin Hung: And Jess, what about you? What will be, what will we be talking about in 12 months?

[00:20:53] Jess Stover: I mean, Derek is absolutely spot on with that. Big data is the key piece to that. COVID, while it didn’t serve us in a lot of ways, it definitely helps to expedite that key component and getting that at our fingertips and having those discussions that we just so need to have.

The only other thing I would add on top of that is communication. And what I mean by that is I still feel as though our technology platforms have an opportunity to connect a little bit more and to communicate more. You’re seeing more and more of this specifically within the EHR side. But I think there’s opportunity to have those push pull type of feeds happening more and more and see more partnerships forming. Whether it be with clearing houses and EMRs, or really any line of technology. How can they integrate more and more and communicate and take it out of being able to pick up the phone and say this is what I see on my side, what do you see on your side?

Just kind of removing more and more of that dialogue so that it’s just automated. And just in the system something happens with the patient and it’s in one system, it automatically flows to so many others.

[00:22:14] Colin Hung: Now, Derek, I can’t leave this interview without asking you to go back to something you said earlier. Tell us about this “fun stuff” that you are doing in your organization in terms of this gamification. Inquiring minds want to know!

[00:22:30] Derek Shaw: No, I got Colin. The gamification platform. I will tell you full disclosure, I am a nerd. I’m an old school Dungeons & Dragons guy. If you’re not gathering experience points, if you’re not achieving levels and tokens and whatnot, then you’re not having fun. And there’s no reason why you can’t bring an orientation like that, a gamificiation platform like that into the workplace.

Everything that happens at Invicta, everything that our staff does for our clients, everything’s codified and our staff acquires experience points throughout the life of their time with us here at Invicta.

You asked me, what are you going to see a year from now a year from now?

I’m hoping I’m going to be telling you about our non-monetary rewards system. So we will build what amounts to silver pieces, gold pieces, and ways for people to, if there’s a project that needs to be done, we’ll call that a treasure chest. And when you finish the project, you’ll get non-monetary rewards internally that you can use for PTO, for shirts, for hats.

I say, all of this because I know there’s a lot of IT folks watching, and keep in mind operations needs you. They need your ideas. They need your creativity. They’re in the weeds. So pull them out of the weeds every now and again and have some fun. There’s nothing wrong with it. You can have fun and do this job at the same time, I promise. If I couldn’t, I’d be retired right now.

[00:24:03] Colin Hung: Well, Derek, I think you’ll have to show us a year from now the pendant you make out of a D20

[00:24:08] Derek Shaw: I will. I’ll send you a D20 with an Invicta shield on it. No question.

[00:24:15] Colin Hung: That would be, that would be appropriate given that you’re collecting XP points.

[00:24:20] Derek Shaw: That’s right. That’s right.

[00:24:23] Colin Hung: Well, thank you. I want to thank both of you for sitting down with us today. You’ve shared a tremendous amount of great insights and information. Thank you so much for talking to us about revenue cycle.

[00:24:23] Derek Shaw: It was a pleasure. It was a pleasure talking with you too, Jess.

[00:24:37] Jess Stover: Yeah. Likewise.

About the author

Colin Hung

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

   

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