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Healthcare Revenue Cycle Mastery

Posted on November 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the trends I see happening today is many organizations focusing too narrowly on things like meaningful use that they don’t take time to handle many of the important financial aspects of a practice. Many people call this revenue cycle management, but I loved how this whitepaper called it Revenue Cycle Mastery.

The reality is that there’s so much more to revenue cycle than most people realize. Most people think revenue cycle is just about focusing on collecting payments quicker and getting more patients to pay their bills. While those are both important aspects of your revenue cycle, there’s much more to revenue cycle mastery. The above whitepaper breaks up revenue cycle mastery into these areas:

Chapter 1 Financial Clearance
Chapter 2 Check-in and Check-out
Chapter 3 Charge Capture
Chapter 4 Coding
Chapter 5 Charge Entry
Chapter 6 Claims Management
Chapter 7 Patient Statements
Chapter 8 Payment and Denial Posting
Chapter 9 Insurance Follow-up
Chapter 10 Denial Management
Chapter 11 Patient Collections
Chapter 12 Payor Management

I’m sure that every healthcare organization can look through this list and see ways that they can improve their organizations approach to revenue. If you’re not sure what each section means, download the full whitepaper where they go into detail on each.

While I’m excited about the benefits of IT on improving healthcare, I also think there’s a tremendous opportunity to use IT to improve revenue. Every chapter listed above could benefit from a well implemented IT system. IT might not always be the right answer, but it can usually help you accomplish some part of the equation faster.

Which of the topics listed above do you think is most important for a healthcare organization to solve first?

The Frustrating but Promising Evolution of Patient Payments

Posted on July 5, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

As a mother of two, and someone prone to over-preparation, I like to have an accurate idea of how much a visit to the doctor’s office will cost me. Am I looking at a $40 co-pay, $100 trip to the ER, or a flat $1,000 fee for pregnancy and delivery services? It’s easy enough to call up Aetna and ask for costs of expected doctor’s visits. It’s not so easy to understand your financial obligation when you’re uninsured and calling around to find a good price on an x-ray for a potentially broken collarbone. The few providers I spoke with to get that X-ray estimate didn’t offer a flat rate, and couldn’t even give me a ballpark figure over the phone. My type A personality was extremely frustrated.

My frustration can in no way compare to the angst the Kennett family felt when Chip, the father, fell ill with lung cancer and had to turn to raising money on Kickstarter to pay the medical bills his admittedly “good” health insurance wouldn’t cover. His wife mentions in a recent Kaiser Health News article that she was overwhelmed by the generosity of friends and family who have so far donated $56,800. “We kept saying how lucky we were,” she wrote in the Team Kennett blog. “Now, just how messed up is that?”

“Messed up” is a pretty accurate description of the frustratingly hard-to-understand patient payment system that has been cobbled together by hospitals and payers over the last few decades. And I’m not even talking about the costs for care. I’m speaking strictly about the methods healthcare providers use to collect their fair share.

I came across a few vendors at the HFMA ANI show I’ve covered over the last few weeks that are trying to take a step in the right direction by offering payment collection methods tailored to patients’ lifestyles. As I told one booth rep, I’d have much rather received the text or email his company offers reminding me to pay the bill for the birth of my daughter rather than the phone call I got from the hospital just two weeks later asking for money. I think all the sleep-deprived, hormonally shell shocked new moms out there would agree that time frame is not the greatest for trying to get money out of us.

I chatted with Bird Blitch, CEO of Patientco, about the need for a more patient-friendly payment collection method after I ran into him on the show floor. Patientco, which is seeing great traction in offering hospitals a variety of payment options that allow patients to choose how they want to pay, is steadfastly working on this very problem. Blitch explained to me that one bad payment collection experience has the potential to ruin an otherwise positive patient experience for a hospital. And it seems to me that hospitals should be paying attention to that last piece of the patient visit to ensure their patients come back to their facility rather than take their business to the competitor down the street. Referrals are fast becoming a big differentiator in most hospital markets, and a bad billing experience can certainly impact word-of-mouth recommendations to friends and family.

Much is being made of the need for greater transparency into healthcare costs. I hope the industry pays just as much attention to the bill that contains those costs. It would be ideal to see them evolve hand in hand.

EHRs Don’t Support Key Parts of Practice

Posted on June 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Ideally, EHRs make the clinical exams more efficient and effective, ultimately saving or even making more money for medical practices.  But the reality is that they bypass other parts of the patient encounter where much of the costs and inefficiencies are generated, according to a whitepaper by athenahealth, “The Economics of Patient Workflow: Cracking the Code of Successful EHR Design.

As the paper notes, 100 percent of practice revenue is generated by the patient exam. Other stages of managing a practice, such as orders and results management, generate 30 percent to 40 percent of costs but no revenue at all. So having an EHR in place which does little to improve exam efficiency — or actually reduces it — is a dangerous thing to do to a practice.

Worse, as the paper points out, there are some major flaws with typical, software-based EHRs:

* They’re too expensive:  Typical cost is $33,000 per physician plus $1,500 per doctor per month for maintenance.

* They don’t save money because they slow doctors down:  Most EHRs force physicians to do a lot of data entry, much in time-consuming, structured formats.

* They aren’t designed to manage the P4P cycle seamlessly:  With most EHRs, doctors have to dig out the data needed to create pay for performance reports.

* They usually don’t offer an efficient, closed-loop solution to the problem of monitoring paper and electronic orders and results:  Remember, orders and result management generates as much as 40 percent of practice expenses.  EHRs’ failure to make such tracking efficient is a major obstacle for medical practices.

Few EHRs support follow-up work from orders and results effectively:  Most EHRs don’t include built-in management and tracking of patient communications, forcing providers to do inefficient and potentially risky manual follow-up.

The white paper goes on to make the argument that there are several reasons why Web-based EHRs solve these problems, largely by requiring no up front cost, using up less physician time on data entry, optimizing collection of data for P4P programs, digitizing all paperwork and tracking practice results.

Are EMRs Going To Generate Billing Audits?

Posted on November 28, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As readers are likely to know, EMRs have already begun to get a bad rap among some payers — most prominently Medicare — as leading to upcoding and padding of services performed on the E/M side of medicine. It may seem a bit unfair for CMS to push for EMR adoption then waggle the finger of disapproval when they lead to billing changes, but that’s how the cookie crumbles.

The thing is, we’re not just talking about disapproval and public chastisements over billing patterns.  HHS has gone a step further than public tut-tutting. In the 2013 work plan for the HHS Office of the Inspector General, the OIG has specifically targeted EMR documentation for E&M services  as an area for study and possible audits:

We will determine the extent to which CMS made potentially inappropriate payments for E/M services in
2010 and the consistency of E/M medical review determinations. We will also review multiple E/M
services for the same providers and beneficiaries to identify electronic health records (EHR)
documentation practices associated with potentially improper payments. (emphasis mine)

According to Betsy Nicoletti, a prominent coding consultant who chatted with me this week about this topic, the OIG is going all out this year, looking at Medicare A, B, C, D and just about every type of provider you can imagine (such as, for example, skilled nursing facilities). Private payers are also getting particularly aggressive in looking for suspect billing patterns, particularly profiles that don’t fit with other physicians in a given specialty.

From what she told me, it’s not that EMRs are automatically suspect, but rather, that EMRs can create inconsistencies and red-flag billing patterns through the use of templates and forms.  For example, CMS may very well notice and audit your practice, she says, if the use of templates leads to using the same code too often (something CMS frowns upon, as it assumes patients’ conditions will vary widely).

If you want to get ahead of possible OIG audit problems, she suggests physicians read the work plan and self-audit in areas that are relevant to their medical practice.  Better safe than sorry, no?

Top 5 Revenue Cycle Management Issues

Posted on September 27, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Like Jennifer, I’m going to be heading to AHIMA 2012 as well. She correctly identifies that ICD-10 is a major AHIMA topic and Upcoding is the topic de jour, but another topic which I think continues to sit under the radar at AHIMA is revenue cycle management.

In many ways this makes sense when you consider that the ICD-10 has such an influence on revenue. Upcoding is all about revenue. Even healthcare documentation is dominated by a discussion of its impact on revenue (Yes, we could discuss why this should be about patient care in a future post). While many don’t want to admit it, humans need to get paid to survive and they want to get paid as much as they can get. Last that I checked doctors were human.

What then are the challenges that doctors face with revenue cycle management (or revenue integrity which many like to call it)? Here’s a great list of RCM challenges as listed by Ruth Zwieg on LinkedIn:

1. Managing the revenue cycle of a practice starts with good Practice Management (PM) software; one that has an easy to use scheduling tool for the front desk and that can determine insurance eligibility before the patient arrives so that the practice can collect the correct co-pay and/or out-of-pocket expenses up front before seen by the physician. This increases A/R and saves time instead of spending resources collecting after the fact which is time consuming and expensive.

2. The PM software must be easy to integrate with their existing or new EMR so that the physician group can show meaningful use and get that incentive money. Many practices still think they have to get new Practice Management software when they start looking at EMRs and many EMR companies try to sway them this way so they can get the sale for their PM software and their EMR.

3. ICD-10 – Need I say more – you have written about this in detail. Some Practice Management systems have a coding assistant built in but most do not. Coding correctly determines payment.

4. Staff training is very important from the beginning of the revenue cycle (scheduling, verifying insurance) to managing the patient once he/she checks in to when the physician sees them to check out and billing/collecting. Just like every other business, time has to be managed and time is money, especially a physician’s time. The more efficient the staff and their use and understanding of the software, the more patients the physician can see.

5. Many hospitals have and still are purchasing physician practices because the physician either does not know the business side of running a practice or just wants to be on salary and get rid of the headaches. Billing for physician practices is different than hospital billing. Hospitals are realizing that their hospital staff may not be doing the best job of that. In addition, the hospitals are realizing that their hospital system’s EHR does not have the desired functionality that a physician group needs or worse, they have multiple physician practices all using different EMRs that the hospital now has to manage or integrate into one.

I find this list really interesting and does speak to many of the revenue challenges healthcare faces. If we could solve these five challenges we’d have done a lot of good for doctors.

Primary Docs See Hope For Stronger Financials With EMR

Posted on September 21, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Apparently, some primary care physicians are optimistic about the financial impact EMRs will have on their practice, according to a new survey.

Vendor Hello Health recently completed a survey of 100 practicing physicians without EMRs to discuss their attitudes about key business issues.  Not surprisingly, 37 percent of respondents said EMR adoption was their number one challenge at present; an equal percentage said that financial issues were their biggest worry.

Here’s what, to me, is the most interesting part of the study.  Among doctors for whom practice financial health was a primary concern, 51 percent felt that implementing an EMR would help solve their problems.

Their theory was that EMRs would help by improving coding and documentation to substantiate claims, as well as improving efficiencies and reducing costs.

Of doctors who didn’t think EMRs would help their financial situation, 46 percent felt that the systems would lead higher costs and overhead, and 15 percent felt productivity would decrease.

Now, I’m going to go all cynical on y’all.

I was pretty surprised to read that some doctors feel EMRs will actually improve their financial situation. Sure, improving coding and documentation itself is certainly a worthy financial goal.  The thing is, that’s not exactly what EMRs are designed to deliver.

As for improved efficiencies and reduced costs, well, I don’t find that very credible at all.  Not that some practices don’t achieve this goal,  but if the respondents  had anything near-term in mind they’re likely to be quite disappointed.

Realistically, if I wanted to invest in technology that improved my coding, I’d go with a computer-assisted coding or souped-up billing system. And I’d begin gunning my ICD-10 engines right away. Getting psyched about my pending EMR is nice, but probably setting oneself up for a letdown.

Study: ICD-10 Could Slam Operations

Posted on September 11, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

We all know physicians are dreading the ICD-10 deadline. Who wouldn’t be a bit blue around the gills if they had to switch from a system with 17,000 codes to one with about 141,000 codes? Now, a study by practice management vendor Nuesoft has given us some specifics as to just what worries them.

Nuesoft surveyed 480 physicians, administrators, office managers and billers in their survey, “Attitudes Toward the Transition to ICD-10 and ANSI-5010.”  All told, they found that 96 percent of respondents were concerned about the transition, with 60 percent reporting that they were “highly” or “significantly” concerned.

As the Nuesoft chart below details, physicians are a bit freaked out over impact of ICD-10. As the chart below indicates, roughly one-third of the physicians questioned were “highly concerned” about the impact of the ICD-10 transition, and another 20-odd percent were “significantly concerned.”

Thirty percent of physicians expect that the ICD-10 transition will affect their operations very negatively, and 45 percent “somewhat negatively.”   The results were more or less the same for the other categories, which included finances, staff state of mind and personal state of mind (physician).

Thanks to Nuesoft for delving further into the headache that will dominate medical practice for years to come. Now, though, Nuesoft, how about a follow up? What I’d love to know, personally, is what differentiates those doctors who weren’t worried from those that are.  That could prove to be an eye-opener. Maybe we have something to learn from them?

P.S.  Now, as a treat for those who made it to the bottom of this piece, here’s Nuesoft’s hip hop video on the subject:


Increasing Revenue Through Clinical Connectivity

Posted on August 27, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you know, I’ve been working hard to create more content related to revenue in healthcare. My interest in this has grown even more since I had the chance to attend the ANI 2012 conference in Las Vegas where I got the chance to talk to people like Rishi Saurabh from GE Healthcare. It’s amazing how many people (myself included) don’t think that revenue cycle management is sexy since there are so many opportunities in healthcare.

One example of missed healthcare revenue management opportunities has to do with connecting clinical content with the financial data. From my experience, it’s quite rare to see a healthcare institution that does a great job of connecting these two pieces of data. The clinical data is in a silo of its own and it’s only looked at by the clinical people. The financial data is in its own financial data silo and only ever looked at by the financial people.

These silos are a problem and present a really big opportunity for healthcare organizations to increase the revenue of their organization. Although, doing so in an organization is not always easy. It takes great leadership to bridge the two content silos. Plus, you need someone who’s effective at understanding both the clinical and financial point of view. So, it’s not hard to understand why this doesn’t happen more often.

I think the most basic example of what I’m talking about can be seen in the annual checkup. I was talking with a colleague the other day when I told him that I couldn’t remember the last time that I’d been to my doctor. In fact, I honestly don’t even know my doctor’s name (which might beg the question of whether he’s really MY doctor). Why hasn’t my doctor sent me a reminder about the need to do an annual physical exam? Why don’t I have a regular connection with my doctor that helps me to take better care of my health?

I think at least part of the answer to this is that the clinical is not tied to the financial. If the clinical were tied to the financial, then the doctor could provide a care plan for me and my specific health needs. Then, the financial could ensure that I’m following that care plan. Imagine the revenue implications of me visiting the doctor regularly as part of a well defined care plan.

I’m sure that many of you out there are likely skeptical about whether patient reminders will actually change behavior. Certainly in many cases, these reminders will be discarded or ignored. However, a certain percentage of those reminders will be followed. This will mean your patients get better care and your clinic increases their revenue. Plus, maybe we need to take a deeper look at the care plans that we offer patients. If large percentages are ignoring the suggestions, then maybe we need to rethink the plan or how we’re communicating that plan to the patient.

There are certainly plenty of other medical examples where a follow up doctor visit would make sense and improve the health of your patients. In fact, you could get really sophisticated with how you reach out to your patient population.

I believe the key to success of this type of program is to integrate the clinical data with the financial data. It creates tremendous power and amazing opportunities.

Revenue Cycle Management Interview with Rishi Saurabh – GE Healthcare

Posted on July 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you know, I had the chance to attend the ANI 2012 conference in Las Vegas that’s put on by HFMA. This conference is a hospital CFO’s home since all of the major players in the healthcare financial management space were in attendance. Around every corner was another Hospital CFO it seemed.

While at the conference, I was able to corner the Global Product Marketing Manager at GE Healthcare, Rishi Saurabh, for a short video interview about revenue cycle management. In the video Rishi provides his insights into the biggest challenges facing hospitals today and also provides some insight into how GE plans to approach these challenges. I hope you enjoy the video:

Will Billing Separate EMR Winners From Losers?

Posted on July 24, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The other day, I was speaking with a sales exec from a medical billing company, who commented that his company interfaces with about 200 of the leading EMRs.  His comment got me thinking.

I believe we haven’t thought enough about billing when we consider what will drive consolidation in the EMR market. Whether vendors offer it through offering their own practice management system or an easy-to-work-with infrastructure, billing counts a great deal. And the EMRs that aren’t integrating seamlessly aren’t exactly in the driver’s seat in medical practices.

Vendors aren’t in the easiest position when it comes to being a good billing partner. They can offer a suite with practice management available as an add-on, but doctors may not want the whole thing. They can offer an EMR + PM suite that’s already integrated, but what if the practice doesn’t like one of the two?  Some vendors are partnering with companies that make third-party billing applications, but if the other party were to pull out abruptly that strategy could enrage customers.

Still, vendors that balance these factors right have a powerful advantage. After all, practices WANT to get Meaningful Use dollars, but they NEED to get paid. I know that billing would be one of the first things I’d consider if I was shopping for a medical office EMR.

What I’m really saying here is that while most of us agree that a big EMR firm consolidation is coming, we haven’t talked much about the role of strong billing support in an EMR’s market viability. I think we should. I’d love to know if you’ve seen medical office software that really has a strong billing approach, and what you like about it. Thoughts, anyone?