Major industry initiatives, such as ICD-10 and meaningful use, are impacting healthcare organizations of all sizes. Due to the significant changes that accompany these undertakings — along with limited internal bandwidth — some organizations are tabling revenue cycle upgrades until after they achieve ICD-10 and MU Stage 2 compliance.
But delaying revenue cycle enhancements can lead to problems later because of the direct relationship between these large-scale initiatives and an organization’s revenue cycle capabilities. For example, it will be harder to fully meet new requirements without technology that links financial and clinical data. Similarly, practices may struggle with implementation if they don’t have responsive technology that automates key financial processes.
Although it may be tempting to put off revenue cycle upgrades, practices would be wise to begin evaluating and onboarding solutions now.
Consider the following strategies when vetting options:
1. Clinical and financial systems must integrate or interface.
As mentioned previously, having technology that connects clinical and financial data is crucial to successfully navigating large-scale initiatives like MU and ICD-10. For instance, to meet MU requirements, organizations must provide discreet clinical data related to specific preventive health measures. While this data is captured in the EHR, it is reported by submitting electronic claims data as part of the revenue cycle process. Being able to link the clinical with the financial ensures the right data is submitted, and providers meet the requirements needed to receive the financial incentives available.
Likewise, integrated data can facilitate a smooth transition to ICD-10 because practices are able to more clearly see how incorrect codes directly impact reimbursement, pointing to improvement opportunities that not only enhance clinical care but also protect cash flow.
When looking for technology, practices may want to consider a single, fully integrated tool, although the expense of this option puts it out of reach for some. Conversely, a tool that connects disparate systems via fluid interfaces is also an option if total integration is not feasible.
2. Technology should facilitate payer and patient payment.
To optimize revenue, practices should look for technology that streamlines critical payer and patient payment processes. For example, technology should offer automated insurance eligibility verification, claims scrubbing based on the Centers for Medicare and Medicaid Services' National Correct Coding Initiative, automated claims submission and the ability to handle denials management. At the same time, a tool should support patient estimates and enable well-informed conversations with patients about their financial responsibility. It should also tie in with the patient portal to make it easier for patients to make payments and reduce the expense of paper-based collections. When patients can use the portal to send and receive both clinical and financial information — prescription refills, test results, patient statements and payment, for example — it can greatly improve patient engagement and satisfaction while also reducing the cost of care delivery.
3. Partner with a forward-thinking vendor.
As simple as it sounds, it is important for a system vendor to be familiar with both the clinical and financial sides of the healthcare business. At the same time, the technology must enable accurate and complete MU reporting and ICD-10 compliance. Practices need a vendor partner that is committed to keeping abreast of healthcare changes and ensuring technology is on the forefront of development.
4. Weigh in-house solutions versus outsourcing.
When looking to upgrade revenue cycle systems, practices may find they can modify existing systems or they may need to purchase new software to accommodate emerging requirements. In addition to the technology costs, organizations must have the resources to manage the upgrade process, track metrics and use the new or revised solution over the long term. Depending on the size of the practice, this can be a large undertaking, requiring substantial financial and human resources.
If limited resources are an issue, outsourcing may be a logical choice. Moreover, if a practice has struggled with poor billing performance, excessive account aging and difficulty recruiting or retaining the right talent, outsourcing may make the most sense. If an organization chooses to outsource, remember to review the vendor’s success with practices of the same size or specialty. Keep in mind that outsourcing still requires dedicated internal management of the billing vendor.
If implementing a new solution seems overwhelming and outsourcing isn’t a viable option, a practice may want to pursue a third strategy — joining with other practices in bringing on revenue cycle technology to save money while still realizing the benefits of a comprehensive solution. For instance, an organization could participate in a group practice initiative to onboard a robust revenue cycle solution that improves efficiency and reduces costs.
5. Don’t delay.
Regardless of size, practices need to examine their revenue cycle systems to determine if they are capable of supporting practice goals. Organizations should prepare now for changes on the horizon or they will find it much more difficult to successfully comply with new population health requirements and achieve the associated financial benefits that come as a result of implementing these programs.
Johanna Epstein is vice president of strategy and executive leadership services for Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation and information technology.