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Optimizing healthcare revenue cycle management in 2017

Ken Bradley, Vice President of Strategic Planning and Compliance, Navicure

If there is one thing the healthcare industry has learned in 2016, it’s that change is constant. With regards to the revenue cycle, for example, increasing patient financial responsibility coupled with pressure to improve overall revenue cycle efficiency has prompted many healthcare organizations to revisit and rethink their current operations.

As 2017 dawns, healthcare organizations are once again facing uncertainty. Although it might be tempting to wait and see how the year unfolds and then take action, this approach can lead to missed opportunities to enhance quality, reduce costs and streamline operations. In particular, the following four revenue cycle strategies warrant attention in the coming year.

1. Improve clinical documentation

Complete and precise documentation goes a long way toward preserving revenue integrity. Not only does it ensure an organization receives all the payment it deserves, it can also limit denials, smooth cash flow and lower the cost to collect. There are a variety of best practices related to clinical documentation improvement, including working one-on-one with clinical departments to boost accuracy and thoroughness. In addition, organizations can implement technology that prompts clinicians to add detail and address all required components.

2. Employ an integrated payment platform

It used to be that healthcare organizations could focus the majority of their revenue cycle efforts on payer reimbursement, making sure claims were accurate and submitted in a timely fashion, and any denials received prompt attention. Although this work is still important, the nature of healthcare reimbursement has changed as patients have taken on greater responsibility for payment – and organizations must respond accordingly. To address this new dynamic, providers must split their attention between payer reimbursement and patient payment. As such, they should look beyond traditional clearinghouse and other payer-focused revenue cycle systems that only optimize claims management and implement more integrated solutions that optimize both revenue streams. These platforms allow an organization to gain a complete picture of the revenue cycle, facilitating efficient claims submission while also cultivating greater transparency with patients.

3. Leverage data analytics

The idea of using data analytics to pinpoint areas of organizational strength and opportunity is not new – many industries have been engaged in this work for years. However, healthcare entities are a little late to the party, especially when it comes to applying business intelligence to the revenue cycle. In a recent survey commissioned by Porter Research and Navicure, more than half of respondents (55 percent) indicated they are not using data analytics to assess and respond to revenue cycle performance. More than one-third of these respondents don’t feel they need such solutions, and nearly 50 percent don’t have the time or resources to use them. 

There are distinct advantages to using business intelligence tools. Most importantly, they allow organizations to gain a clearer picture of their strengths and weaknesses and zero-in on improvement opportunities. Not only does this lead to better performance, but it also helps the provider target resources to areas that need them most.  

When looking for a data analytics solution, organizations should make sure the technology has defined mechanisms for communicating performance information. For instance, dashboards can highlight performance at-a-glance while reporting tools can facilitate root-cause analysis. Solutions should also provide benchmarking capabilities so that organizations can compare their performance over time and with peers.

4. Be more transparent with patients

As patients face increasing out-of-pocket costs, they are starting to expect more information from providers about their financial responsibilities, asking about treatment costs, payment options and whether an organization offers payment plans. To meet these expectations, providers must shift patient financial conversations to the front end of the revenue cycle, employing automated tools that verify eligibility and estimate costs. The more information a provider can share upfront, the less confused patients will be and the more likely they are to meet their obligations. To further prompt payment, organizations should offer convenient payment options, such as online bill payment or secure credit card on file solutions.

Similar to the use of data analytics, there is room for growth in this area because many organizations are not currently using patient-friendly payment tools. According to an August 2016 survey commissioned by Porter Research and Navicure, only 33 percent of respondents have price estimation tools, 26 percent send electronic statements, and 25 percent utilize a credit card on file solution.

Driving performance amidst changing times

It will be interesting to see in 12 months how the healthcare industry has evolved and how organizations have responded to those changes. Those that focus on improving clinical documentation, employing integrated platforms, leveraging data analytics and increasing transparency with patients can ensure their revenue cycle stays strong no matter what the new year brings.