The job is always interesting for those in hospital revenue cycle management and 2018 looks to be a pivotal year for specialists in this industry focus. We take a look at some tips, trends, and tactics in this post.

Can you have both low cost and high quality with RCM?  Jason Fugleberg, RN, BSN, Vice President of Patient Services/Chief Nursing Officer at Millinocket Regional Hospital, a Critical Access Hospital (CAH) in Maine, thinks maybe you can. In a Q & A interview with RevCycle Intelligence, he said:

“I think our primary financial goal is reducing cost and increasing quality. I don’t think anybody’s going to cost cut their way out of this difficult healthcare reform that we’re in. We’re going to have to expand revenue. That means expanding service lines.” — Jason Fugleberg, VP of Patient Services/Chief Nursing Officer at Millinocket Regional Hospital

Is outsourcing hospital revenue cycle management an option?  Perhaps.  A recent article in Modern Healthcare may have even identified a trend:  “As providers continue to look for ways to cut operating costs and boost their top lines, more are handing over their bill collection and claims processing business to the experts rather than managing it in-house.”

Getting proactive in RCM solutions.  As an article in Health Leaders Media points out,  “revenue cycle leaders can fall into a trap of merely managing problems that pop up. But the danger with a “fix it” approach is that so many of the challenges in revenue cycle are connected.”

Hospital revenue cycle talent in demandBecker’s Hospital Review listed 12 hospitals seeking smart RCM people in February of this year.  This follows a similar post the month before listing 10 hospitals seeking RCM talent.  We have an earlier post listing the skills C-level hospital leaders are looking for in these positions.  In addition, the Healthcare Information and Management Systems Society (HIMSS), has a certification course for “Certified Revenue Cycle Representative (CRCR)”.  The course is designed to provide the “the necessary framework to help set standards of performance and build technical expertise across the entire revenue cycle.” HIMSS says that “CRCR certification is recommended for hospital revenue cycle staff and associated departments including Patient Access; Patient Accounts; Health Information Management; Billing Department; Case Management: Compliance: Decision Support; Finance; Financial Representatives and Managed Care Operations.”

Technology trends to support hospital revenue cycle management.  An article in Health Data Management identifies four areas of focus:

  • Bots are driving the balance sheet.
  • Artificial intelligence teams with the bot.
  • EHRs finally become revenue generators.
  • The focus needs to shift to help patients pay their out-of-pocket expenses. The advice is to “look for robust and accurate tools that assist with producing estimates and collecting from patients.”

The patient is the new payer.  Another Healthcare Finance article observes that “the balance of billing revenue has shifted significantly, with patients now accounting for 30 percent of healthcare revenue on the back end. For instance, a hospital bills $1,000 for a service. Nowadays, about $300 of that will actually be paid by the patient.”  A related article in Healthcare Dive notes that “patients are now the third-biggest payer behind Medicare and Medicaid.”  The writers observe “That’s led hospitals and other providers to shift bill collection efforts, with a focus more directly on patients. It’s an entirely different process that’s more expensive and labor-intensive.”  The game plan to deal with this?  “Financing plans, coupled with financial education, can reduce patient stress and make care more affordable.”

The role of the chargemaster in hospital revenue cycle management is evolvingRevCycle Intelligence recently published a long thoughtful article explaining the role a chargemaster — the comprehensive master list of codes and hospital fees — in an era of increasing calls for pricing transparency.

EHR, billing and insurance costs vary a lot.  A recent study published by JAMA (Journal of the American Medical Association) found that “in a time-driven activity-based costing study of personnel and overhead costs in a large academic health care system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure, representing 3% to 25% of professional revenue.”

Do patients lose their way in your hospital revenue cycle?  In an article in Healthcare Finance, patient engagement specialist Jan Oldenburg tells a typical story where “plenty of anecdotal evidence that patients are caught in a vortex of frustration, like one story of a client who tried to simply find the cost of an ultrasound. The man carried a $6500 deductible and wanted to be prepared… it took 15 phone calls and web research to get to pricing information and what might be a reasonable price. Ultimately, he was billed the wrong amount and it took more phone calls to resolve that issue.”

The SSI Group has a primary focus on hospital revenue cycle management for our hospital clients, and we will continue to keep you posted as developments and trends become clear.