Six Tactics to Restore the Healthcare Revenue Cycle

This article is based on thewebinar presentation, “New Ways Forward: A Panel Discussion on Navigating the Revenue Cycle in 2021,” with a panel of experts including Terri Rinker, MT (ASCP), MHA, Executive Director of Revenue Cycle Performance, Community Health Network; John Settlemyer, MBA, MHA, CPC, CHRI, Assistant Vice President, Revenue Cycle, Atrium Health; and Suzi Tschetter, MBA, CPA, Director, Revenue Integrity, Cleveland Clinic.

With the release of the COVID-19 vaccine andeased restrictionsfrom the CDC, health systems are on the path to financial recovery. However, organizations still have a lot of work ahead to make up disruptions, including months of lost revenue from halted profitable elective procedures that cost health systems an average of$50 billion per monthand changing reimbursement rates fortelehealth services.

When it comes to revenue cycle improvement, many organizations think of operating margins, but the pandemic affected more than profitability. Facing new work environments and changing legislation (e.g.,telemedicine reimbursement), revenue cycle teams must adapt to restore revenue integrity and keep up in this evolving healthcare landscape.

Six Tactics for Healthcare Revenue Cycle Recovery and Success

As organizations continue along the path of revenue cycle recovery, revenue cycle teams should consider how to adjust their traditional routines to the pandemic-induced changes including pivoting to remote work environments. Healthcare revenue cycle leaders should consider six proactive strategies to help them navigate pandemic-era changes and promote near- and long-term revenue cycle success:

#1: Prepare for Changing Legislation

在立法改革期间，可能将重点放在报销上，降低成本和更有效地提供护理将是成功的一个关键因素。在这种不确定的环境中，技术是收入周期领导者的关键，因为它能够快速适应新的要求。Health systems can prepare for future changes with robust financial products (e.g.,Health Catalyst PowerCosting™) that attribute cost to every facet of a patient’s experience, providing insight into the true costs of care delivery.

Healthcare revenue experts also predict changes to thelist of procedures医疗保险将会报销，并立法防止病人意外支付医疗费用。Surprise medical billing legislationwill most likely aim to reduce out-of-network surprises (e.g., if an ambulance takes a patient to an out-of-network system).

总体而言，收入周期领导者应注意立法举措对经济的影响。有了意识，组织可以适当地准备变更，保持重要的收入流，或者补偿其他领域的损失。

#2: Create Positive Remote Work Environments

The pandemic forced healthcare revenue cycle teams to transition from traditional in-person work settings to remote work environments. Many organizations lacked the technology, infrastructure, or culture for this rapid change. To provide a positive remote work experience, organizations can take a proactive approach by offering ongoing technical support in case of technical glitches. This allows revenue cycle team members to feel more connected to the company and each other and removes barriers, such as connectivity issues.

Other ways revenue cycle leaders can increase remote workplace engagement include the following:

• Scheduling daily virtual huddles for team members to share work or personal achievements and updates.
• 在会议期间共享网络摄像头，这样团队成员就可以看到彼此的反应，并把面孔和名字联系起来。
• Recognizing team members’ birthdays, work anniversaries, and other important dates.
• Implementing effective onboarding practices for new remote employees.

Tactic #3: Manage Payer Policies

支付人政策随时可能发生变化，使得组织难以跟上最新的发展。Additionally, payers don’t always communicate these policy changes to health systems, so organizations need a proactive policy approach that considers multiple policy update sources:

• CMS Listserv: CMS emails can be a good source for policy updates and CMS notifications.
• Payer-provider advocate meetings: Revenue cycle leaders should start payer-provider advocate meetings with policy updates to glean any recent changes.
• High-priority areas: If a health system has limited resources, it should focus more on policy changes around high-dollar, high-volume areas (e.g., oncology drugs) and less on policy changes involving low-dollar, low-volume areas (e.g., labs).
• VitalKnowledge®:VitalKnowledge根据卫生系统选择的标准向卫生系统发送关于相关政策更改的可定制每周警报。
• Team member responsibility:Ensure the revenue cycle team member responsible for contracting and reimbursement (typically the reimbursement analyst or contract management analyst) is up to date in payer communications and policy changes. Analysts can typically stay informed of Medicare/Medicaid policies through the email options, such as the CMS ListServ and VitalKnowledge. However, for private payers, analysts should manage updates in payer contracts and look for opportunities to include policy change language in payer contracts to reduce the need for constant monitoring. Health systems should also specify the method by which a payer is required to notify the provider of any policy changes and when those changes could go into effect.

#4: Expand Telehealth

COVID-19引发了远程医疗的增长，使卫生系统能够遵守社交距离指导方针，并仍然照顾患者。远程医疗对收入至关重要，因为它使护理团队能够跟踪可能出现不良结果和慢性疾病的患者，这两种疾病都可能对卫生系统的收入产生负面影响。通过技术提供持续的护理可以防止健康恶化，从而降低卫生系统的成本。

For a sustainable telehealth approach, organizations should consider new telehealth technologies (e.g., sophisticated live video conferencing tools for better remote monitoring) and expanding telehealth to other service lines that will increase access to hard-to-reach populations, such as patients with limited transportation or impaired mobility.

#5: Set Up Prior Authorization for Surgical Procedures

Revenue cycle leaders should invest in pre-registration procedure processes. Pre-registration allows the health system to verify a patient’s coverage and obtain appropriate authorization from the patient’s insurance company before the procedure. Unfortunately, health systems may submit verification and authorization after the procedure, then don’t receive payment because the insurance company didn’t cover it. Prior authorization eliminates the risk of missed payments and ensures the health system receives payment for surgical services rendered.

#6: Work Towards Price Transparency

Many health systems implemented the CMS-requiredprice transparency regulationsat the start of 2021. While this was a step toward achieving price transparency, additional requirements are on the way. Starting in 2022, CMS will require providers to generate good-faith price estimates for all services scheduled more than three days in advance and provide those estimates to the patient’s health plan or the patient (if the patient is uninsured).

Patient cost estimators—tools that use procedure cost information and a patient’s health insurance information to estimate the patient’s out of pocket cost—will play a key role in achieving price transparency. However, accurately predicting a patient’s costs relies on the health system knowing the correct billing structure and reimbursement they will receive from the payer. Price transparency aims to normalize point-of-service collections for patients. To further improve the patient billing experience, health systems should offer payment options, such as payment plans or alternative payment models.

Healthcare Revenue Cycle Leaders Can Face the Future

As health systems settle into the next normal, revenue cycle leaders will continue to face an unpredictable pandemic aftermath. Healthcare revenue cycles have suffered, but organizations can now recover lost operating margins. Applying the six tactics for healthcare revenue cycle recovery and success described above and adopting an agile mindset will help revenue cycle leaders guide their teams with confidence, restore revenue integrity, and accelerate cashflow.

Additional Reading

你想了解更多关于这个话题吗?Here are some articles we suggest:

1. A Five-Step Audit for Peak Charge Capture Performance
2. Five Ways Activity-Based Costing Can Maximize Earnings
3. Charge Capture Optimization: Target Five Hotspots to Boost the Bottom Line
4. The Healthcare Revenue Cycle: How to Optimize Performance
5. Predicting Denials to Improve the Healthcare Revenue Cycle and Maximize Operating Margins

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