Author Archives: Rachael Rethwill

The Keys to Successful Healthcare Revenue Cycle Management

Keeping pace with the changes in healthcare RCM can seem like a daunting task that takes considerable expertise, time, and resources. Today, medical professionals spend more money billing and collecting than in any other industry, and even with powerful management software and trained employees, maximizing clinic profits can be a challenge.

Creating a well-maintained healthcare revenue cycle management process can make a huge difference in a clinic’s bottom line but how do you know if your RCM process is doing what it should?

Measuring Effectiveness in Healthcare Revenue Cycle Management

Understanding the effectiveness of your current healthcare revenue cycle process is key to identifying what needs change or improvement. In general there are four pillars to successful RCM in healthcare:

People

They are the backbone of a well-managed revenue cycle. Healthcare veterans have experience in coding, compliance, electronic data exchange, customer service, billing/ collections, and more, and are the ones capable of managing every aspect of a business.

Process

When followed with strict adherence, the RCM system will guarantee results. The process is made up of data collection, claims submission, AR processing, automation, specialist prioritization, and other steps. Working with information, structure and discipline is what produces reliable higher performance.

Technology

It is used across the entire revenue cycle process. It allows for effective tracking, automation, and interaction, and can be used by a large pool of employees with minimal expertise. It enables every task in the process to be performed quickly, accurately and consistently.

Information

It takes good data to improve any revenue cycle performance. Having access to critical data delivered in simple reports will pinpoint problems and identify opportunities. In today’s market, BI is critical to increasing both efficiency and profits.

Healthcare Revenue Cycle Flowchart

The RCM process is complicated – to assess the quality of your RCM process there are many tasks and functions that need to be looked at together. This healthcare revenue cycle flowchart provides one way of thinking about the elements of the RCM process.

Healthcare Revenue Cycle Management Flowchart

Current Challenges in Healthcare Revenue Cycle Management

Every clinic is facing a set of core challenges that require a thoughtful approach to overcome. The old notion of ‘billing and collections’ is changing and expanding – the revenue cycle process now encompasses almost every aspect of a practice. It is becoming more automated, regulated and complex. These are a few of the challenges clinics need to consider to create a healthy RCM process:

  • Maximizing performance – Declining reimbursement and rising costs means practice needs to capture every earned dollar.
  • Minimizing cost – Payment per claim is flat if not declining, and RCM costs are only increasing.
  • Compliance – More complicated than ever, and with higher stakes.
  • Business intelligence – Increasing the need for sophisticated data to drive business.
  • Integration – RCM platforms rely on an expanding ecosystem of technologies that have to function in tandem.
  • Migration to Value-Based Reimbursement – New RCM processes that are different from Fee-For-Service.
  • Direct patient payment – With the increasing costs of health insurance, this is a large source of revenue.
  • Staff recruitment and retention – It is harder to find and keep talent (low end salaries get less skilled workers, higher skilled workers are in demand and harder to retain).

Improving Your Clinic’s Healthcare Revenue Cycle Management

If you are looking to improve the way your clinic manages its revenue cycle, you might be considering changing or implementing new practice management software or outsourcing your RCM entirely – both of these are good options to take your healthcare RCM process to the next level.

For even more information about healthcare revenue cycle management – including RCM best practices for every step of the revenue cycle – you can download our comprehensive Revenue Cycle Management eBook for free.

Download RCM eBook

Why Consider Revenue Cycle Management Outsourcing?

Without a doubt, the healthcare revenue cycle is one of the most important pieces of your business. Choosing the best revenue cycle management strategy for your organization is crucial to keeping the cash flowing and decreasing staff costs.

Many clinics do revenue cycle management in-house, but as they grow and their revenue expands they find the that the RCM process requires more time and skill and the likelihood of clinical errors increases. This is why many clinics consider revenue cycle management outsourcing as a solution. Third-party RCM experts can remove the errors from your RCM process and alleviate the stress of keeping the clash flowing.

If you are wondering whether you should outsource your revenue cycle or continue to do it in-house, there are a few key things to consider before making a decision.

Healthcare RCM Outsourcing

In the past, healthcare RCM outsourcing decisions hinged on just a few issues. With the changes in the industry, the decision matrix for a practice has expanded and the case for outsourcing RCM to the right partner has grown. Today the RCM process is very complex and requires skilled and knowledgable workers and revenue cycle management outsourcing considerations have also grown more complex.

Past revenue cycle management outsourcing considerations

Control: Because it was mostly a manual process, practices perceived that in-house operations gave them more control.

Staffing: Whether or not the practice was able and willing to manage the billing staff was often a key consideration.

Cost: Performance variations were perceived to be small between high and low RCM performance, so the economic decision was simply a comparison of in-house costs vs. outsourcing fees.

Revenue cycle management outsourcing considerations today

Control and transparency: With the complexity of the RCM process, real control
is no longer achieved by simply having the staff down the hall on your payroll, but by having processes that are measured, reported, tracked and managed as outlined in this paper. Outsourcing providers can invest in these capabilities in ways that in-house billing operations cannot.

Full effort: A common concern about outsourcing is whether the service provider will work as hard as in-house staff to collect on difficult claims. Setting aside the questionable assumption that employed staff are more motivated than an outsourcer, a fully measured and transparent process is the best assurance for getting the right level of effort on hard to collect claims.

Talent: The RCM process now requires so many skill sets that even practices with a fairly large number of providers cannot have all of the necessary people on staff. Additionally, in low unemployment environments, it is hard for many practices to find and retain qualified RCM employees without their wages escalating too quickly.

Compliance: The compliance risks – both billing and data security – for a practice related to its revenue cycle are simply too great to ignore. Many practices cannot make the investment required to properly manage those risks, but outsourcing providers are able to spread the costs of compliance investments across multiple clients.

Technology: Likewise, the number of technologies required to support the revenue cycle grows every year. The capital, operating expense and talent required to build and support these technologies give the outsourcer the advantage of scale that is passed on to the practice, something that cannot be done if RCM is kept in house.

Management focus: Most administrators are now trying to navigate the practice through the ever changing healthcare landscape and nd they just have more on their plate than they can manage. Major strategic initiatives such as growth, health system relationships, and dealing with new competitive threats must take priority, along with the day to day rhythm of managing their physicians, staff and clinic operations. Allowing a trusted partner to manage their RCM and the technology that goes with it allows them to focus on what matters most.

Economics beyond cost: While the cost of outsourcing is still an important factor, there are other economic considerations as well. There are significant differences in collections and cash performance that dwarf small differences in RCM cost. As the revenue cycle becomes more and more automated, the outsourcer invests their capital to build capabilities, allowing the practice to use its capital elsewhere.

Is Outsourcing Revenue Cycle Management The Right Choice For Your Clinic?

Clinics have a number of pieces to weigh when deciding how to manage their revenue cycle, but in the end the final decision is unique to each clinic. If you find your clinic struggling to keep up with modern RCM then outsourcing is a great way to relieve some of that pressure.

If you want more information about revenue cycle management outsourcing and whether your clinic has a healthy RCM process, check out our in-depth Revenue Cycle Management Ebook.

GE’s Healthcare IT Business to be Acquired by Veritas Capital

HealthCo is excited to announce that  GE Healthcare has reached an agreement to sell its ambulatory care, revenue cycle and workforce management software businesses to Veritas Capital.  GE’s Centricity Practice Solutions is included within the acquisition. 

Veritas is a leading private equity firm that invests in companies that provide critical products, services and technology-enabled solutions to customers worldwide.  Veritas is well-capitalized with a strong ability to invest for growth.

These new owners bring a culture of intense customer focus and a drive for growth through focused R&D and product innovation, as well as a deep understanding of the urgent need to digitize our healthcare system. Additionally, they have a strong track record of strategically transforming leading companies in the healthcare information technology space.

GE Healthcare and Veritas will work together to ensure a smooth and professional handover after the transaction closes, which is expected in the third quarter.

HealthCo will continue “business as usual” and go above and beyond to make this transition seamless for our customers. HealthCo remains committed to keeping you proactively informed and satisfied with our services.

Please join us at GE’s State of the Union where you can learn more about the transition and have an opportunity to ask questions:

GE State of the Union Webinar Registration

For Centricity Practice Solution and Centricity EMR Customers
April 20, 2018
12:30PM EDT | 9:30AM PDT

Register

Another way to stay informed is to attend Centricity LIVEMay 16-18 in Las Vegas, where you will be able to connect directly with Veritas leadership to get the latest information regarding the transition. The conference will also include a series of breakout sessions designed exclusively for Centricity customers to give you a first-hand look at what’s next on the Project Northstar journey and provide you with tips, strategies and best practices that you can put to immediate use. 

In the meantime, please know that we believe transparency in communication is important so don’t hesitate to reach out, we will answer your questions openly and honestly.

Again, we are incredibly excited to share this important news with you, and we look forward to the journey ahead.

MACRA is not the Macarena But It Is A Dance You Can Learn

The Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA, is on the minds of physicians and practice managers from coast to coast. As with any new ruling from CMS, the challenge is to fully understand the changes to the law and what it means for your practice. Change is never easy, but this change has to be met head-on, or the clinic’s bottom line may suffer.

To help address your questions about MACRA, GE Healthcare is hosting a webinar called “MIPS, MACRA and YOU in 2018” on Monday, November 27th from 9:00 a.m. to 10:00 a.m. Pacific Time. The webinar will feature Mark Segal and Donna Maddox from GE Healthcare, and David Swartout from Mountain View Medical in Forest Grove and Hillsboro, Oregon.

While MACRA presents a host of new challenges for clinics, Donna Daniel of IBW Watson Health argues that managing and analyzing patient data is the core function that clinics must learn to master.

Provider performance will be measured against national peer performance to establish goals, incentives, and payment structure. Organizations that perform well against the quality benchmarks while controlling costs will be financially rewarded. Those who miss the mark may see their Medicare reimbursements shrink. This puts a great deal of pressure on providers to immerse themselves in performance metrics.

We all know that practicing medicine has plenty of its own pressures. Know that you can lean on HealthCo and GE Healthcare to help you manage MACRA/MIPS.

Understanding Merit-based Incentive Payment System (MIPS)

MIPS replaced the Physician Quality Reporting System, Value-Based Modifier, and Meaningful Use of electronic health records programs. It also added a fourth component, Improvement Activities, which is intended to give physicians credit for their efforts to reduce disparities in care, engage patients in shared decision-making, and other activities designed to improve care.

Instead of three separate programs, MIPS is designed to be one cohesive program with a single score for each physician or group. The score will be derived from four components: quality, costs, improvement activities, and advancing care information.

Sandy Marks, Assistant Director of Federal Affairs at the American Medical Association, notes that MIPS presents a variety of special challenges for small and rural practices.

When Congress enacted MACRA, it recognized the unique challenges facing physicians in small and rural practices. For example, the law required CMS to set a low-volume threshold so that physicians who do not treat enough Medicare patients to have a chance at getting a positive return from participating in MIPS would be exempt from it. MACRA also called for creating virtual groups so that physicians in small and rural practices can combine their resources to jointly report on MIPS measures.

Get A Firm Grip On 2017 MIPS Reporting

Under MIPS, each clinician will be measured against four categories: quality, cost, improvement activities and advancing care information. Quality is the most important category right now, as it accounts for 60% of the clinician’s overall score. Each clinician under the MIPS program receives a final score (from 1 to 100) and that number determines the amount of payment the clinician is eligible to receive in 2019.

If you’d like to learn more about these four reporting categories, CMS has excellent “explainer” videos on the topic available.

Our dedicated team of Centricity Practice Solution specialists is also available to walk you through any specific MACRA- or MIPS-related questions.

Accurate ICD-10 Coding Is Critical To The Clinic’s Bottom Line

GE Healthcare’s Centricity Practice Solution, like all business-essential software, helps remove complexity from tasks that would otherwise be unmanageable. For one, the clinic’s EHR software must assist physicians and medical coders in the clinic with the correct choice of ICD-10 codes. With more than 68,000 options in the International Classification of Diseases database today—up from just 13,000 in the ICD-9 standard—the likelihood of human error is too high to proceed without automated assistance.

To provide just one example, “degenerative myopia with retinal detachment” has five ICD-10 codes assigned to it, not one. This granular level of detail helps describe the precise diagnosis. The good news here is we have Clearinghouse tools available in Centricity to help you manage the complexity of ICD-10 coding and maximize revenue.

Improving clinic workflows is another critical aspect in getting ICD-10 right the first time. Data is only as good as the inputs received, which squarely places the responsibility on the clinic’s physicians to make the accurate call at the point of care. You never want the clinic’s coder(s) to guess which code is correct after the fact and input the wrong code or series of codes. That will quickly make for an unnecessary billing logjam. The chain of communications from physician to coder to payer needs to be flawless, or payments will be denied or lost in the system.

“The idea is to minimize billing time, reimbursement time, get a clean claim and get money get faster and improve cash flow,” Denver Wade Harless, who works for the Sacred Heart Health System, told Healthcare Finance News. Harless believes “a lot of clinical legwork needs to be done to get more specific information from physicians.” Our take is, workflow improvements are always highly beneficial, but workflow realignments, in combination with added functionality in the EHR, produce the biggest wins for the clinic.

Four Keys To ICD-10 Coding Success

1) An awareness of the issue and a commitment to solve it
2) Physician training to help identify the right codes at the point of care
3) Customization and optimization of Centricity
4) Select clinic workflow improvements (determined on a case by case basis)

There’s no question that the challenges in value-based care, including keeping up on the latest developments in ICD-10, puts an extra onus on practice administrators and physicians. The complete solution includes hiring talented coders, internal training, process improvement, and software upgrades.

Our implementation team at Quatris Healthco is available to discuss your ICD-10 questions on a call that I am happy to set up fro you.

Better Data Leads To Improved Care And Higher Profits

Meeting the various reporting and measurement standards imposed by CMS is no cakewalk. On one hand, clinicians must be adept at change management. On the other, they must be technically proficient and knowledge rich.

There can be no doubt that successfully practicing medicine today requires clinicians to overcome several significant challenges. It’s our job to reduce at least one challenge—and we do, by clearing the path to payment under value-based care.

Shiv Gopalkrishnan, GE Healthcare’s General Manager of Enterprise Financial Management Solutions, addresses one problem head-on when he asks, “How can we deliver solutions faster through the cloud?”

In busy clinics, resources are limited, which puts an extra onus on technology to do more of the heavy lifting. As Centricity migrates to the cloud in 2018 and beyond, physicians and practice managers will begin to benefit from the “no touch, low touch solutions” that help drive automation, which leads to optimized workflows and a notable reduction in workloads around the clinic.

Gopalkrishnan says, “Whether it is clinical outcomes, financial outcomes, or operational outcomes, we know with value-based care, these are all going to be tied together. You’re going to get paid because you demonstrate clear clinical outcomes and quality of clinical outcomes.” He adds, “It’s very important that we deliver a solution suite that helps clinics achieve these net financials.”

In order to deliver the results our partners in clinics count on, GE Healthcare and HealthCo bring a true understanding into provider workflows and reporting requirements. Thanks to our years of experience working in clinics and with clinics, we also understand the pressures involved (in making big changes) and how to relieve them.

Let’s recap. The “Triple Aim” of value-based care can be summarized like so:

    1) Reduce the cost of healthcare
    2) Enhance the patient experience
    3) Improve population health

At HealthCo, we are on board with all of the above. We also come to work each day ready to deliver on these core promises:

    4) Enhance care quality
    5) Improve provider efficiency
    6) Strengthen financial performance

We know the move from fee-for-service to value-based care is a big change, and the entire transition cannot normally be made all at once. It takes time, a solid plan, and reconfiguration of systems to properly record the numerous measures of quality that help determine the overall health of your patient population.

Remember, you need to demonstrate improvement to get paid today.

According to RevCycle Intelligence:

Value-based reimbursements are calculated by using numerous measures of quality in determining the overall health of populations. Unlike the traditional model, value-based care is driven by data because providers must report to payers on specific metrics and demonstrate improvement. Providers may have to track and report on hospital readmissions, adverse events, population health, patient engagement, and more.

We are happy to help you refine your tracking procedures and update your workflows to meet the need of value-based care. Measuring the full set of outcomes that matter most to patients is indispensable to better meeting patients’ needs. It is also one of the most powerful vehicles for lowering health care costs. Let’s work on it together. Better care at a lower cost is a promise for the future that is within reach today.