The story of Greenway Health is a story of change. It’s a story of partnerships. It’s a story of converging missions coming together to focus upon the needs of the healthcare industry.
In the first interview of our “Voices of Greenway Health” series, I spoke with Robin Hackney, Chief Marketing Officer. She provided an extensive outline of Greenway Health’s past and its evolving vision of its future. In particular, we learned about the company’s mission to “serve, connect and care.” For the second part of our “Voices of Greenway Health” series, I spoke with Tina Graham, Senior Vice President, Revenue Services, Greenway Health, to develop a deeper understanding of how she and her revenue cycle team strive every day to approach their work in a manner that embodies their company’s first mission pillar to “serve” – to serve its physician base, their patients and the healthcare community as a whole.
Graham has around 20 years experience in healthcare. She started out working at a health maintenance organization (HMO), on the payors side. “It was interesting for me because it gave me a good background on how payors work and how they set up all of the rules that adjudicate claims and some of the technical nuances of those things,” said Graham. She then transitioned into a company that provided software tools to payors to help them manage their workflows and to manage claims adjudication, claims entries, etc. From there, she moved on to serve as Chief Operations Officer for a company called SuccessEHS in Birmingham, Alabama, where she performed many technical and customer-facing tasks. After multiple acquisitions and mergers, Grahams moved to her current position at Greenway Health.
(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article. Part three of this four-part series will be published in February.)
Free: Please describe how your team works with physicians.
Graham: Our revenue cycle services organization is a fairly large team that provides revenue cycle management services to our entire physician base.
That mindset, we believe, is yesterday’s thinking. There are a lot of things that go into the revenue cycle. We believe that every member of a clinic has the ability to impact the revenue cycle, so we consider our service as not an over-the-wall approach. It’s very much a partnership with the client to drive revenue and to make sure that the right things are being done at the right times to make sure that our physicians are getting paid for their good work.
Free: Greenway Health has unveiled its new mission to “serve, connect and care.” From your perspective, what is your criteria for determining if your work as fulfilled the pillar of service?
Graham: We firmly believe that service is about all the people at the receiving end of healthcare. That’s not limited to physicians and patients. There are a lot of people involved. We try to take a more holistic approach to our offerings. We always say, “We are going to be more than just this one thing.” We are really going to look across the industry with the goal of improving patient outcomes, and improving physician efficiencies. We are focused on all of those different recipients in the healthcare lifecycle, to say, “What can we do to offer a holistic offering that really touches on all of those areas and makes them better?”
Free: When one considers the nature of ICD-10, Meaningful Use and other standards that our industry are being held accountable, it seems as though more companies need to have a deeper appreciation for interacting with and serving the customer. During your colorful career how did you develop these deeper appreciations and what areas of customer engagement are you striving to address in the future?
Graham: One of the cool things about healthcare is that it’s changing all of the time. It’s one of those jobs where there’s something new to learn everyday.
Focusing specifically on the revenue cycle, I think there’s such a huge opportunity today to look at that cycle differently than we ever have before. Traditionally, medical practices have looked at it as almost a brute-force kind of role. In other words, you have a group of billers that just are doing whatever they have to do to make sure claims are corrected and filed, and arguing with payors over denials. Some of that work gets done and some of it doesn’t because at the end of the day there’s not enough time to do everything, right? As we have transitioned over the years, we now say to our clinics, “We are going to be a partner to you, and all of us influences this process. All of us have the ability to impact whether or not you are going to get paid, and we have a really cool opportunity to positively impact that with innovation.”
Doctors want to see patients. And if you asked a doctor, they will say, “I went into this profession so that I could provide good quality care, to see patients and make their lives better, not so that I could mess around with a computer, or fight with a payor everyday. My job shouldn’t be that hard and it seems like it’s getting harder on a daily basis.”
We have a great opportunity within our organization to really improve the way the doctors’ day goes and let them focus on patient care. We just have to do the right things and embrace innovation and new service offerings. We have to look at the process as less like a brute-force method and just be smarter about it. Let’s look at it from the beginning of the cycle and do smart things all along the way and be as efficient as we can with that and then we will get good results and we won’t be frustrated when we get there.
Free: You mentioned earlier in our conversation the notion of brute force. With that in mind, let’s turn our attention to ICD-10. What do you believe will be ICD-10’s legacy now that it is here and working?
That doesn’t mean that it’s not impacting them. People were impacted differently depending on their level of preparation and who they partnered with and how their partners are prepared for it. Luckily, it’s not having that huge impact that we felt like it might financially on the practices.
From a revenue cycle perspective, ICD-10 is a really big deal for us. We spent months preparing our teams because we want to try to minimize denials and the industry was preparing us for a big bang. CMS published something at one point that said we should expect a 100 percent to 200 percent increase in denials and that practices should reserve money. As an industry, we were all bracing for something really terrible to happen. I will say the preparation for that sort of an event and taking that viewpoint going into it was the right way to prepare because what it resulted in was us really pushing clinics to be better prepared to makes sure they’ve trained their teams on how to code.
We certainly pushed our revenue cycle team to be well prepared. We even got down to the point of, “What information do we need to have prepared if we need to argue a denial with a payor so if they are incorrectly denying a claim? What best prepares us for that discussion?” All of that prep was great for the team. It was great for our customers.
It has not been a big bang. It has been less eventful than we had all been preparing it to be. What is happening, from all of the things that we are hearing and seeing with claims adjudication, is that a lot of payors took a more lenient approach because there’s an opportunity to introduce a lot of denials. There’s a lot more codes now and denials are based on codes, and coding combinations, so there is a opportunity there for it to have a negative impact on physicians and for payors to really tighten that up, and I don’t really think they did that out of the gate. However, I’m sure in time what we are going to see is that those things will filter in and we see them tightening up on denials.
Just a very basic example is around laterality. You still have to code laterality in a modifier, and you also code it in a diagnosis code so they could start matching those things. Some payors are now, but some other payors aren’t. They are being lenient with that and following CMS’ guidelines within this transition period and accepting claims if your codes are in the right family. That will all tighten up, and when it tightens up, I think, will vary by payor so it’s still very important for physicians to be prepared and be proactive. If we allow our physician partners to become complacent, our team fails in terms of providing the service that we feel is vital to our mission.
Free: Are you seeing any similarities between how people in the industry viewed and prepared for ICD-10 and how the industry is currently viewing and preparing for Meaningful Use?
Graham: Meaningful Use is another one of things that could be painful, or it could be less painful if you are better prepared for it.
There are a lot of things that you have to be mindful of with Meaningful Use and, I think, the positive thing is it has driven some standardization. It can be burdensome for physicians, but, again, physicians need to look forward, right?
Free: What is Greenway Health’s perspective on value-based payment reporting?
Graham: When I look at value-based reimbursement, I think the big thing is when these kinds of things come up, there’s a ton of change in the industry and there’s a lot of these initiatives that come up and some of them don’t really pan out and some of them do. That being said, the reimbursement model is changing.
It’s important for physicians not to ignore it. To get a good understanding of it. We are trying to get them to do that through educational series and revenue cycle. I am putting together a more structured talk track and learning track for physicians, but it’s important because it’s not just a means to get paid. It’s a way to report data for the industry to get smarter about it. Therefore, physicians have to be smarter about that too and they have to look at it with that view and understanding that the data that they are reporting to payors, in this case, is important and it’s meaningful and it will become more meaningful over time. Not to mention that it impacts the way they get paid.