As hospitals and health systems face rising payer denials and delays in resolution, pressures increase to better manage cash and cash position, research shows. How are revenue cycle leaders strategizing to improve revenue recovery and reduce aging A/R?
Industry veterans Candice Powers, Jason Driskell, and Matt Fisher shared examples of some wins at HFMA's Region 5 South Eastern Summit.
Orient Discussions with Payers Around Data
Powers, Chief Revenue Officer at USA Health, described how the organization participated in a one-year free trial of a data sharing collaborative with the Alabama Hospital Association and Hyve Health. She says it became a lot easier to attack issues with the payers once her organization had a better sense of provider and payer performance across her state and other participating states around things like bill-to-pay timelines, denial rates, different types of denials, and the attributable area of the denials. "You can also compare your commercial relationships versus Medicare Advantage plans versus traditional Medicare and Medicaid," she said. As a result, she says calls with payers are much shorter and more productive, with the ability to objectively view data and focus on solving root issues instead of spending time on problem identification.
"Before we were flying blind, just our own experience. And now, we can speak knowledgeably to the other experiences across the state and know when we are performing in the top percentile. So, it's been a huge help to us," she says. The organization has since extended the data collaboration and benchmarking under a paid arrangement.
Key Takeaways for Revenue Cycle Leaders:
💡While access to benchmarking data on denials and payer performance varies considerably across the industry, hospitals and health systems should take steps to fully optimize data within their EHRs and through relationships with service partners. Ensuring comprehensive data capture and mapping is key to preparing for effective root-cause analysis and will best position the organization for data-based payer negotiations.
Examine Team Structures for Opportunities
At a previous organization, Driskell succeeded in tackling utilization review by taking the unusual approach of having case managers report under revenue cycle. Now, in his first year as AVP of Revenue Cycle at Conway Medical Center, he is replicating these wins with the same structure.
"The reality is when you look at their job day in, day out, it is financial," he says, pointing to how case managers oversee length of stay for safe and appropriate discharge in alignment with documented clinical status, or how the clinicians often review Medicaid eligibility for a greater than 30-day length of stay.
"There has been this historical pushback by health systems for them not to report to finance simply because they are nurses. But each day, those utilization review staff are effectively trying to fight the good fight of a status assignment or determination of inpatient versus observation."
Key Takeaways for Revenue Cycle Leaders:
💡Functional or project-based workforce structures may help leaders uncover new-found productivity and effectiveness. Successful revenue cycle leaders also will examine in-house vs. outsource arrangements in areas requiring specialized expertise or exhibiting relatively low occurrence.
Don't Overlook the Patient in Your Denials Management Strategies
Fisher discussed how three-way calls with his staff, the insurer, and the patient–using the insurer's patient line–were aiding time to resolution and providing a more positive patient experience at Piedmont Healthcare. "When we can take that approach with patients to walk them through a difficult process (of discovering why payment of a claim is delayed or denied), we're the winner," he says. His organization has also focused heavily on front-end processes to reduce coordination of benefits issues and the associated patient frustrations.
Key Takeaways for Revenue Cycle Leaders:
💡Experts in COB and patient involvement denials use various tools to optimize processes, from workflow and insurance discovery technologies to automated dialers, performance-tested communications, and ongoing staff education. When claim dollar values are high and other means of contact haven't been successful, hospitals can benefit from carefully planned and executed home visits.
About Knowtion Health
Knowtion Health is a leading provider of technology-enabled revenue cycle management services. The company leverages AI-driven technology and deep domain expertise to reduce denials and underpayments across all denial types, low balance accounts, and complex claims, while enhancing patient experience and satisfaction. Recognized as an Inc. 5000 fastest-growing company, Knowtion Health is a multi-year recipient of the Black Book award, which honors top partners as ranked by healthcare providers. To speak with an associate about your denials program, please give us a call at 561-995-1252 or email Services@KnowtionHealth.com.
