Lessons from the Revenue Cycle Shop: The Day Our Defects Became Cash

February 26, 2016

As the leader of an organization that provides health care revenue cycle optimization services, I talk with many hospital financial and IT directors who juggle the competing demands of quality improvement, electronic health record (EHR) capabilities and information exchange, ICD-10 migration, and more. They struggle to carve out the time and resources needed to manage the revenue cycle for the greatest possible return.

Here’s how one revenue cycle manager met this challenge and helped his organization turn payment “defects” into dollars.

With bundled payments and value-based payments appearing on the revenue cycle landscape, I knew my revenue cycle operations needed to change.

The Impact of Value-Based Payments and Accountable Care on Hospital Revenue Cycles

The cycle was becoming more complex as the health care delivery model changed and billing/payment processing changed. We struggled to find available talent in the industry who could get their heads around effective revenue cycle management. Leadership in our health care organization was underestimating the complexity of the revenue cycle, because so much of the focus was on clinical key performance indicators (KPI).

As a result, I knew I needed to rely on new technology that would bring more revenue cycle efficiency and effectiveness to our health care organization, while maximizing dollars to the bottom line. We needed a game changer so we could unlock data and get to the granular level to resolve issues, then take action, and bring resolution to outliers. We also wanted to be able to push granular level detail to portfolio workers.

Analyzing Patient Billing Data, More Time Addressing Non-payments

Like many revenue cycle leaders, I was spending valuable time extracting reports from our system and data warehouse, downloading the data to spreadsheets, massaging it, and then trying to do something effective with it. We were spending 80 percent of our time compiling and analyzing disparate data to identify what we wanted to take action on, leaving only 20 percent of our time to actually do something about it.

Longitudinal Patient Billing Records Help Target Opportunities for Conversions

We finally found a unique solution that helped us thread all the disparate data together, creating a longitudinal patient record. We began to convert defects and outliers that were previously written off or denied into cash—positively affecting our organization’s bottom line and increasing resources.

It was a challenge, but once we committed to giving the technical aspects of the revenue cycle the unique attention they needed, the functionality of the data warehouse (the one that was doing great for our clinical KPIs) was elevated for us.

Outsourcing Gives Us the Flexibility and Bandwidth to Optimize Our Revenue Cycle

We know more changes will come. We expect expenses will continue to be squeezed, even in the face of increasing volumes. Our unique solution bodes well for facing these challenges—it enables us to get at root causes, reducing our write-offs and increasing our collections. We went granular with our technological solution, did not impose a burden on IT, and it worked! Learn more about this transformation.