3 Trends from the Revenue Cycle Management Virtual Summit

When patients are actually healthcare consumers

In the wake of high-deductible health plans and other cost-sharing arrangements, patients owe more out of pocket for their care. Providers are well aware of this trend and have been working on aligning their billing and collection workflows to account for such a dramatic increase in patient financial responsibility.

However, Lankford Wade, chief financial officer at Summit Health in New Jersey, is challenging providers to think about the patient financial experience differently.

“[T]he patient financial experience landscape has changed dramatically,” the keynote speaker said at the Revenue Cycle Management Virtual Summit. “It used to be that best-in-class revenue cycle organizations were solely focused on maximizing collections, which certainly is near and dear to me wearing my hat as the chief financial officer. However, today, best-in-class organizations look to leverage each and every patient engagement opportunity as a way to drive total lifetime value of a customer.”

To do that, providers need to realize that most patients are seeking a modern experience, and not just on the clinical side of the organization.

“I would rather call our patients ‘healthcare consumers’ because they are shopping around for the best experience, and that experience needs to include quality of provider care, convenience of location, and the capability to schedule on their own terms,” Wade explained. “All of this makes sense given the fact that consumers get this type of experience in nearly every other industry.”

“[H]ealthcare has been able to get away with a subpar customer billing and collection experience for far too long, but this certainly will need to change.”

Tapping into online and text-based communications has been key for organizations like SummitHealth. SummitHealth has also developed its own patient-facing app so users can schedule and manage appointments, access pre-and post-visit results, share laboratory results, and connect with a provider.

“[W]e are looking to create a true patient engagement experience that mirrors if not improves upon the type of experience consumers get in other industries,” Wade stated. “This way we can leverage each and every patient touchpoint in order to keep a better pulse on their needs and desires and help to continue to guide them across their healthcare journey.”

Physician education key to claims denial prevention in value-based care

If coding goes in cleanly and accurately, then an organization’s chances of recouping payment from claim denials are higher. That was the message from Corella Lumpkins, CHC, CPC, CPCO, CPB, CPPM, CPC-I, CCS, CCS-P, manager of coding, compliance, and provider education at Loudoun Medical Group, P.C.

But when organizations rely on their physicians and other clinicians to do the bulk of medical coding—and this will increasingly be the case in a value-based world—then physician education is key to reworking and ultimately preventing claim denials, the revenue cycle management veteran stressed at the Revenue Cycle Management Virtual Summit.

“Probably more than half of all of [the] coding at my institution is done by the actual providers. [E]ducation, training…and things to facilitate that front-end process are very important when you have a setup like that,” Lumpkins elaborated.

Physicians at Loudoun Medical Group undergo robust onboarding, which includes coding compliance regardless of a physician’s experience. Getting ahead of potential coding issues or questions is important to Lumpkins, as is the tools and templates she creates in the EMR.

“That’s the perfect time to get with physicians, when they’re developing their templates…That’s the [clinical documentation improvement] moment,” Lumpkins stated.

Education alongside the right resources and technology sets the foundation for claims denial prevention, especially in a value-based world. Under value-based contracts, physicians are even more key to coding and clinical documentation. Without the right quality information, organizations risk payment and other incentives.

But physician education is also critical when an organization does get a claim denial.

“As far as the backend portion, trying to get that denial information that we're receiving from our backend, from our accounts receivable departments and feeding that information directly back to the provider who's assigning the codes,” Lumpkins said. “If you can…identify [which] provider is doing this specific thing during the denial process, we try to take that information and include that in our interaction with the physician. Again, look at their template, look at their EMR, look at the tools they're using to try to fix it before [the claim] becomes [denial].”

Going remote-first

Working from home used to be a perk for high-performing revenue cycle management staff. Now, some healthcare organizations are using a remote-first strategy not just for their own staff but also new hires.

“Remote work is here to stay,” said Dennis Shirley, MBA, CHFP, vice president of revenue cycle at UnityPoint Health. “[W]e’ve significantly reduced our real estate footprint. We couldn’t bring everybody back to the office if we wanted to.”

“From our perspective, it’s more about how we continue to utilize the advantages and really mine those advantages of remote work to allow us to maximize our benefits organizationally and for our team members.”

UnityPoint Health already had about half of its back-office staff working remotely before COVID-19 but that percentage quickly jumped with the onset of the pandemic. With the right resources and productivity measures in place, those jobs are now staying remote and UnityPoint Health is using the remote-first strategy to fill in workforce gaps.

“[Our] footprint and growth…has been a major change for us,” Shirley stated. “We now have revenue cycle personnel living in 31 states. We operate out of three states. With [remote work], we’re able to recruit talent that is not limited to our geographic region, which has really been key for in maintaining our staffing ratios throughout the broad shortages across the industry.”

The University of Kansas Health System is also keeping many of its revenue cycle personnel staff at home or wherever they feel comfortable working, and remote work has also helped to address industry-wide staff shortages. Colette Lasack, the health system’s vice president of revenue cycle, credits success with remote work to a whole team of people.

The University of Kansas Health System relied heavily on its IT department to ensure revenue cycle staff were equipped to work remotely in a secure manner. The health system also worked and continues to work closely with payroll and HR to remain compliant with labor laws, especially as staff move in the wake of the pandemic and new staff from different states sign on.

Establishing productivity and quality metrics for staff working remotely and those in the office was also foundational to The University of Kansas Health System’s success with a remote-first strategy.

“[A] lesson we're learning is we have to adjust our productivity measures because now it's no longer five minutes to work an account. Now it might take you eight, whatever the measure is, just based on the fact that we're elevating the work that our folks need to do in order to resolve an account,” Lasack explained, referring to the fact that the health system has implemented technology in the wake of remote work to automate more workflows.

With automation in place, revenue cycle staff are generally touching more complex cases since the technology can handle the low-hanging fruit. This has shifted productivity measures while Lasack has implemented more flexibility for workers.

For information on upcoming virtual summits, click here.