Preventing denials, implementing automation, and bridging departmental gaps are just some of the tasks these revenue cycle executives are leading out at their organizations.
Gender equality in the healthcare C-suite hasn't yet been attained—a recent study showed only 33% of senior leaders in healthcare are women—but there are many women executives that are bringing strong strategic leadership to their revenue cycles every day.
In an attempt to underscore those underrepresented, HealthLeaders has chosen four revenue cycle leaders worth highlighting for their achievements in preventing denials, implementing automation, and bridging departmental gaps in the revenue cycle.
Stacy Reck, director of CDI/utilization review at Avera Health
In most revenue cycles, the clinical documentation integrity (CDI) staff is responsible for reviewing documentation to ensure that it supports reported diagnoses and for collaborating with staff to update documentation that is insufficiently supporting medical necessity.
Because your CDI teams have such a heavy hand in documentation review, they make it the perfect place to start when shoring up clinical validation denials.
Reck has streamlined multiple strategies for preventing clinical validation denials before they happen. Reck has also led her team at Avera Health on initiatives that helped to lower MS-DRG downgrades and financial takebacks.
Christy Pehanich, AVP of revenue cycle management at Geisinger Health System
Most revenue cycle leaders have started implementing automation in one sector or another of their department, but while automation may seem like a simple fix, collaboration is usually needed with teams beyond the revenue cycle.
More leaders are bringing in their IT teams to help streamline their revenue cycle automation, and just as Pehanich has done at Geisinger, successfully collaborating with IT and merging skill sets is a necessity in optimizing revenue cycle automation.
Melissa Woods, assistant vice president of revenue cycle financial clearance at Ochsner Health
It's clear that operationalizing processes to generate reliable, accurate good faith estimates (GFE) is necessary and has pushed many organizations to enhance their technology to ease this burden for their front-end revenue cycle.
Woods has done just that at Ochsner by looking internally at their preexisting software while filling in any gaps with a third-party vendor. She played a large role in, what she calls, the organization's “hybrid approach” to its GFE technology implementation.
Tami McMasters Gomez, director of coding and CDI services at UC Davis Health
It was a priority for McMasters Gomez to implement the best technology for her CDI and physician teams to improve their workflows and ensure maximum reimbursement for the organization's middle revenue cycle.
Since implementing new technologies for CDI and physician teams, with the help of McMasters Gomez, UC Davis has seen an overall improvement of physician workflows, improved documentation accuracy, and an almost 5% increase in comorbidity capture rates.
The Director of Revenue Recovery at Memorial Hermann Healthcare System talks through perfecting patient billing processes and what’s in store for the future.
Revenue cycle leaders are in search of ways to better secure revenue by bolstering their technology and streamlining processes, and if perfecting the patient billing experience isn’t on the radar, a big opportunity could be missed.
Patients care about the billing experience—so much so that 56% of respondents in a recent survey said they would switch providers if the experience was poor.
In addition, the study showed that personalization and consistency were regarded as important to the billing and payment experience. Personalization was very important to 42% of respondents and somewhat important to 41%, while consistency was regarded as very important to 59%.
It’s obvious that patients are more likely to be satisfied with their healthcare experience if the billing process is transparent, accurate, and efficient. And while patient satisfaction is reason enough to optimize the billing and payment experience, a streamlined billing process leads to faster and more accurate reimbursement and improved cash flow.
So how can revenue cycle leaders perfect their billing processes?
Tonie Bayman, director of revenue recovery at Memorial Hermann Healthcare System, said during the Patient Financial Experience NOW Summit that honing patient billing processes on the front end is creating greater patient financial satisfaction at her organization.
“We have a new tool that we’ve recently started using to measure satisfaction, and we can see the comments about what has happened prior to service,” she says. “While we aren’t at the bedside treating somebody clinically, what we do matters in relieving the anxiety.”
Another area revenue cycle leaders can look to create a positive financial experience: financial clearance, Bayman says.
Based on focus group data, Memorial Hermann is working on an additional offering to grant patient financial clearance to some patients before they are scheduled for service to help them on their financial journey. “Patients have told us they want to know that everything’s taken care of…and that they have an authorization before they ever schedule the appointment.”
Bayman says that the industry will likely see more vendor consolidation in the next five years as providers invest even more time and resources into improving patient payment processes.
“[Revenue cycle leaders] have a lot to manage now, and it’s better for them if they can pair down to one or two vendors,” she says. “There’s going to be more consolidation and newer technology that’s going to help manage some of this complexity,” says Bayman.
By making meaningful and intentional changes to the patient billing experience, providers can ensure the financial journey leaves a positive lasting impression on patients, families, and caregivers.
"The proposed changes (Model V28) would make significant changes to the existing V24. V24 was structured using the ICD-9-CM codes and, although translated to ICD-10-CM, did not provide the granularity we are now able to with code assignment," Laurie Prescott, interim director for ACDIS and director of CDI education for HCPro, said in a recent issue of CDI Strategies.
This change means that more specificity in code assignment will be required in a number of condition categories, upping the administrative burden on certain revenue cycle staff.
The proposal increases the number of payment-HCCs by 29, with a total of 115 payment HCCs.
"These 115 HCCs have been renumbered, and new names have been applied to many groupings. Within the methodology, 268 new codes have been identified, but in total V28 demonstrates a reduction of 2,027 diagnoses codes that provide risk adjustment within the present version," Prescott wrote.
Major medical groups are now responding and taking aim at the short comment period, which was scheduled to end the first week in March.
According to AMGA, the proposed changes to the risk adjustment model would adversely impact healthcare providers participating in value-based care contracts.
In addition, AMGA disagrees that removing codes from the HCC model addresses discretionary coding variation, but instead would remove distinct clinical differences from the model.
"CMS should not move forward with its proposed change until stakeholders understand what the impacts of these changes will mean to the Medicare Advantage plan design and care delivery, particularly to patients with chronic conditions such as diabetes and congestive heart failure," the AMGA said in a press release.
"Modifying the HCC model is not a simple technical update or revision," said AMGA President and CEO Jerry Penso. "It’s likely to have significant ramifications, affecting both plans and providers. CMS should recognize that stakeholders can’t provide substantive, constructive feedback in such a short timeframe."
If CMS’ proposals are finalized, Medicare Advantage plans must submit bids based on the new model by June 5.
Major medical associations demand CMS resume all disputed No Surprises Act payment determinations.
The American College of Emergency Physicians, the American College of Radiology, and the American Society of Anesthesiologists are urging CMS to quickly resume all independent dispute resolution (IDR) payment determinations paused by its February order.
While CMS provided some relief at the end of February when it instructed certified IDR entities to resume making determinations for payment disputes involving services provided before October 25, the associations are calling on the agency to resume swift determinations for disputes after that date too.
As background, CMS temporarily halted the IDR process payment determinations following last year’s district court ruling before they were again reinstated. The medical associations assert that the government’s pause exacerbates the existing backlog of IDR determinations, causing harm to healthcare providers who provided those services.
Drew Smith, director of revenue cycle at MainStreet Family Care, talks implementing text-based bill pay and creating a positive patient financial experience.
Digital payment options are becoming increasingly important for revenue cycle leaders as they seek to bolster their technology and better secure revenue. Perfecting and expanding these options should be a priority, especially since the same challenges that made 2022 the worst financial year since the start of the pandemic haven’t abated.
With patients increasingly demanding convenient, digital payment methods, healthcare providers must adapt to meet changing expectations to stay ahead of the competition, and this is what Drew Smith, director of revenue cycle, at MainStreet Family Care is trying to achieve with its new, text-based bill pay.
“We reduced the volume of paper statements mailed to patients by 11%—and this represents significant savings for our 46-facility system. We’ve also saved five hours in manual work per week for our revenue cycle team, or 260 hours a year,” Smith said.
During his conversation with HealthLeaders, Smith touch more on this and chatted about implementing this new technology, what it means for the systems’ patients, and how it significantly decreased accounts receivable days.
HealthLeaders: Why was it imperative to improve the patient billing experience?
Drew Smith: MainStreet Family Care serves a primarily rural population in Alabama, North Carolina, Georgia, and Florida, and often, we are patients’ only option for care. Even though we’re an urgent care center, people in our communities often turn to us for primary care because of the lack of providers available locally. Some of the areas we serve have a county hospital people can turn to for care, but many do not. Without access to care for conditions like diabetes, which impacts people in rural areas more severely than those in urban areas, the health of these communities would severely decline.
So, it’s vital that we have a healthy balance sheet. This means we depend on patients to pay their out-of-pocket costs of care in a timely manner. But research shows 40% of patients are often confused by their bills. Moreover, consumers believe healthcare providers can make it difficult for them to pay their bills. And in rural areas in particular, we’re finding that inflation is affecting residents’ decisions on whether to seek care or delay treatment. This makes clear communication around how much patients owe for their care after insurance and their options for payment crucial.
Pictured: Drew Smith, director of revenue cycle at MainStreet Family Care. Photo courtesy of LinkedIn.
HealthLeaders: How did you determine there was a need for text-based pay?
Smith: We chose text-based bill pay because we wanted to make it easy for patients to understand their financial responsibility for care and simple to pay their bill. Our goal was not only to speed payment but also reduce cost to collect. Paper statements cost $6 per statement for our organization based on paper and postage costs, the time it takes to post physical checks and respond to returned mail and the need for a lockbox. When we improve cash flow and reduce our cost to collect, we strengthen our ability to open new facilities and extend care to underserved areas—and that promotes better health.
One of the things that was attractive to us about text-based bill payment is that we could reach patients through the device they use most: their cell phone. In the rural communities we serve, most adults own a smartphone. We also don’t get charged when we have an inaccurate mobile number for the patient or the text hasn’t been successfully delivered. And the experiences of AccessOne, the vendor we work with, indicated patients pay their medical bills faster when they receive text notifications for payment. We estimated we could save thousands of dollars a week just by avoiding paper statements for a portion of our population while speeding cash flow.
HealthLeaders: How did your patient population respond to the change?
Smith: We saw an immediate impact on our ability to collect payment sooner through text-to-pay. Since rolling out mobile pay in 2019, 14% of our patients pay their medical bill using our secure text payment feature. Among patients who use mobile pay, 95% pay their balances within two weeks. More than 80% of this bucket make a payment before a paper statement is ever printed. We also offer patients the opportunity to self-enroll in a payment plan using their mobile phone. This makes the process of payment plan enrollment much more convenient. It also adds an element of privacy by enabling patients to take this step from the comfort of home.
Initially, there was some skepticism among our staff about how patients would respond to text-based payment. However, for us, the initial response to text-based medical bill payment was strong. We’ve found that by branding text-based communications to have the same look and feel as other MainStreet Family Care communications, patients more readily accept mobile pay as a valid vehicle for payment.
But that doesn’t mean we haven’t had to modify aspects of our approach. Even as mobile pay exceeded our expectations, when we reached out to patients for feedback, we discovered some people felt the language used in our communications was a little aggressive. In some instances, patients thought the messages were spam. We took a second look at our messaging to soften communication, and the response has been pretty positive. We plan to take another look at our messaging to make sure it still resonates with those we serve in a high-inflation environment.
Of course, some patients still desire paper statements—and that’s OK. Today, we wait a week after a text-based notification is sent before mailing a paper statement. This gives us time to capture payments from those who prefer to pay us electronically while respecting the preferences of those who still want a paper statement. We also allow patients to opt out of mobile notifications.
HealthLeaders: What other benefits has this change created for your organization?
Smith: Text-based payment significantly decreased our cost to collect and our days in accounts receivable. We reduced the volume of paper statements mailed to patients by 11%—and this represents significant savings for our 46-facility system. We’ve also saved five hours in manual work per week for our revenue cycle team, or 260 hours a year. That’s time that can be directed to more value-added tasks, like patient financial counseling.
HealthLeaders: How has the implementation of digital patient payment options improved the patient experience for your organization?
Smith: Digital payment options give us another way of creating better patient financial experiences—and not just around payment. For instance, when patients receive a text from our mobile pay system, they can easily call us with questions right from the payment screen. Many patients who view their statement via text end up calling to make a payment over the phone or update their insurance information. This is a return on investment that may not be reflected on our performance dashboard, but it’s made our call center a better-performing channel while creating stronger connections with patients. We’ve found that the benefit of taking an omnichannel approach to payment is that it builds trust with patients by meeting them where they are. By creating a seamless, consistent financial experience, we can leave a positive impression that carries over to their next encounter with our facility.
Are you interested in sharing your expertise on this topic? Join one of our panels for the upcoming Patient Financial Experience NOW Summiton April 19. E-mail revenue cycle editor Amanda Norris at anorris@hcpro.com for more information on joining the conversation.
A new survey shows that the CDI industry has made inroads toward the higher ends of compensation. See how your revenue cycle is stacking up.
Staying competitive in the market has been top priority for revenue cycle leaders as they work to navigate an ever-changing workforce landscape—and a new survey lets revenue cycle leaders in on compensation and hiring trends for CDI staff.
Despite the continually tightening margins for healthcare organizations, no ground has been lost for clinical documentation integrity (CDI) staff compensation, according to the 2022 ACDIS CDI Salary Survey.
In fact, the survey results, which garnered responses from nearly 800 CDI professionals, show that the CDI industry has made marginal inroads toward the higher ends of compensation since it's 2021 survey.
According to ACDIS' 2022 survey, 14.84% of survey respondents reported making $90,000–$99,999 annually. Those in the highest earning brackets (earning $100,000 or more per year) rose more than 12 percentage points from 2021, making up 53.68% of all respondents in 2022. The percentage of those in the lowest salary bracket—$59,999 or less—was 2.50%, according to the survey. Mirroring last year’s results, most programs have up to five staff members at the facility level (35.51%), followed by those with six to 10 staff members (22.88%).
At the healthcare system level, the largest portion of respondents (25.52%) reported having more than 50 staff members across all sites, which is in line with the fact that many systems represented in this survey were on the larger side (3,000 or more beds), the ACDIS report said.
In 2022, 49.10% of all respondents said their program plans to hire in the next 12 months.
Of those who plan to hire in the next year, the vast majority (89.43%) said they plan to hire for CDI specialist positions, followed by 15.43% who will hire for second-level reviewer positions and 14.00% who will hire for CDI lead positions.
This is on trend with a separate survey of hospital and health system CEOs, CFOs, COOs, and other executives that found that 53% of those surveyed expect at least a 10% staffing increase for IT/coding/rev cycle experts at their organization in 2023.
For programs trying to secure funding for additional CDI staffing, Anne Robertucci, vice president of clinical revenue cycle at Prisma Health in Greenville, South Carolina, told ACDIS that she suggests investigating reports that show the program’s performance in comparison to similar local organizations.
Whether a program looks at CC/MCC capture rate or quality measure performance, if its results are lower than similar institutions, that could be leaving money on the table—which is a compelling case for organizational leaders responsible for approving new positions. Use that comparison data to paint a picture of what the program could do with additional staffing resources, Robertucci suggested in the report.
“I think it's about data. Compare yourself to other like facilities. [Vendors] love to compare you to other organizations. Go out and look at MedPAR data. If you're not at the 75th percentile, that's money lost and money to be gained. Tell a story comparing of how you look to others. Your quality data tells a story, and there are soft dollars behind that as well,” she says. “Money talks, and I think this is one area where it's so easy to build a business case to support adding staff.”
The fact sheets detail the timeline of waiver expiration dates for different providers, as well as policies and programs that have already been terminated or made permanent. Certain waivers are slated to end at the PHE conclusion, while others have been extended.
The American Hospital Association (AHA) released a special bulletin that highlights the key provisions mentioned in these waivers. Several notable policies and programs will be affected when the PHE ends, including the following:
Skilled nursing facility (SNF) bed requirements and availability
Bed limits and the 96-hour rule for average length of stay for critical access hospitals
Requirements for discharge to SNF, rehabilitation center, long-term care hospital, and home health agency
Medicare’s 20% add-on payments for patients diagnosed with COVID-19
The AHA also sent a letter to HHS with recommendations on stabilizing the healthcare delivery system, supporting healthcare workers, and removing unnecessary administrative and regulatory burdens throughout the PHE conclusion.
While some waivers have been extended for two years, other freedoms—including an important Ryan Haight Act provision—will end soon, forcing some providers to take action now. Read more about this here.
HealthLeaders' regulatory round up series highlights five essential governing updates that cover every aspect of the revenue cycle that leaders need to know. Check back in each month for more updates.
The revenue cycle is complex, detailed, and always changing, so staying on top of regulatory updates and latest best practices requires revenue cycle leaders' constant attention in this ever-changing industry.
In this revenue cycle regulatory roundup, there were an ample number of updates published by CMS and the OIG in February, including public health emergency (PHE) updates and the OIG’s Work Plan.
Guidance was released for rural emergency hospital provisions, conversion process, and conditions of participation.
CMS published a memorandum to state survey agency directors containing guidance on the new rural emergency hospital provider type.
The memo outlines requirements on delivery of care, the conversion process for eligible facilities, survey guidelines, and the conditions of participation that facilities must meet to participate in the Medicare program.
Updated fact sheets were released on COVID-19 PHE waivers.
CMS updated a series of fact sheets about COVID-19 PHE waivers in light of the recent announcement that the Biden administration plans to end the PHE on May 11.
These fact sheets are located on the “Coronavirus Waivers & Flexibilities” webpage and are not dated on the main page but have all been revised as of February 1. They detail which flexibilities will remain after the PHE and which will not. The Hospitals and CAHs, ASCs, and CMHCs fact sheet discusses the end of the Hospital Without Walls program as well as the end of several telehealth flexibilities that were permitted during the PHE.
CMS said in an email that it will continue to provide resources and guidance via its current emergencies webpage as the PHE winds down.
CMS rolls out three new drug pricing models in response to the Biden Administration’s executive order on drug prices.
CMS published a press release to announce that it has selected three new drug pricing models for testing by the CMS Innovation Center in an attempt to help lower prescription drug prices. This action is in response to the Biden Administration’s Executive Order directing HHS to consider additional actions to further drive down prescription drug costs. The three drug models include:
The Medicare $2 Drug List: Also referred to as the Medicare High-Value Drug List, this model encourages Part D plans to offer a low, fixed copayment across all cost-sharing phases of the Part D drug benefit for a standardized Medicare list of generic drugs.
The Cell & Gene Therapy Access Model: This Medicaid model would have state Medicaid agencies assign CMS to coordinate and administer multi-state outcomes-based agreements with manufacturers for certain cell and gene therapies.
The Accelerating Clinical Evidence Model: This Part B Model involves having CMS develop payment methods for drugs approved under accelerated approval to encourage timely confirmatory trial completion and improve access to post-market safety and efficacy data.
CMS published a fact sheet and FAQ on these three models. It also published a report regarding the response to the executive order.
A comparison of average sales prices and average manufacturer prices for the third quarter of 2022 was released by the OIG.
The OIG published a report regarding drugs for which the average sales prices (ASP) exceeds the average manufacturer prices (AMP) by 5% or more for two consecutive quarters or three of the previous four quarters.
When this happens, CMS substitutes 103% of the AMP for the ASP-based reimbursement. In the third quarter of 2022, 15 drug codes met this price substitution criteria. Eight additional drug codes exceeded the 5% threshold but were identified as being in short supply. Another 18 drug codes had ASPs exceeding the AMPs by at least 5% in the third quarter of 2022 but didn’t meet other price substitution criteria. The OIG will provide these results to CMS for review.
The OIG made updates to it’s work plan.
The OIG updated its Work Plan with the following new items:
The revenue cycle is making its way to the forefront of financial planning for 2023.
A recent analysis by HFMA and Guidehouse, which surveyed 182 hospital and health system CEOs, CFOs, COOs, and other executives, found that 53% of those surveyed expect at least a 10% staffing increase for IT/coding/rev cycle experts at their organization in 2023.
This doesn’t come as a surprise since workforce has been a hot-button issue for revenue cycle leaders as the revenue cycle workforce wasn't immune to the drastic changes happening in healthcare over the last several years.
Bill Arneson, director of revenue cycle process and system support, at Moffitt Cancer Center, recently told us that assessing your budget is one of the first steps you need to take when filling revenue cycle roles since it will determine if you need to develop your talent in-house or if you can hire from outside the organization.
“If you can’t afford to hire the star IT people, then you have to commit to developing them. Ask yourself, are you the New York Yankees with unlimited money? Or are you the Tampa Bay Rays who have to work the farm system and develop players?” Arneson said.
As for the areas with the greatest projected budget increases for 2023, 20% of leaders said digital engagement/virtual care is their greatest projected budget increase this year, followed closely by revenue cycle automation (18%).
With growth in labor and supply costs, many leaders are turning to AI, automation, and digital care strategies to improve engagement and efficiency, the report said.
This isn’t the first time we have heard about the push for more revenue cycle automation in 2023 either. In fact, Amanda Schutz, billing services officer at Avera Health, recently shared her plans to advocate for its revenue cycle to make greater financial investments in automation for 2023. “That could be through AI, bot technology, or any technology that allows us to be more efficient in our day-to-day work,” she says.
There is an obvious need for patient payment platforms, but revenue cycle leaders aren't letting vendors off the hook.
Revenue cycle leaders are in search of ways to better secure revenue by bolstering their technology, and if perfecting and expanding online payment options aren’t on the radar, a big opportunity could be missed. And while this is area of need for revenue cycle leaders, vendors need to better perfect their offerings.
Receiving payments at the hospital is still the predominant way consumers settle medical bills, but according to a new study that’s changing as awareness of online portals and unified digital platforms grows.
The research found that nearly 30% of the entire sample used an online portal to pay a medical bill in the past year. “In the same timeframe, 36% of consumers paid bills in-person at a provider’s office or healthcare facility. That gap of roughly 7 percentage points is closing faster as more consumers become aware of new online payment options,” the study said.
The heat is not off vendors, though, as providers have rightly high expectations for the tech.
While most providers have seen an implementation of new patient payment solutions in the past five years, the platforms still have room for improvement for both providers and patients, according to a separate survey recently analyzed by HealthLeaders.
In that study, 650 providers in the U.S. shared their experiences with patient payment solutions and what more they want out of the platforms.
Only 58% of respondents reported high satisfaction with their current patient payment systems, with 30% saying the implementations were not successful.
Revenue cycle leaders know that patients expect payment methods that are both convenient and efficient, but that doesn’t mean any and all payment platforms are worth the time and effort.
Providers also want to make their own lives easier, which includes fully integrating patient payment solutions with their EHR—something only 33% of respondents reported having. More than half (58%) said the seamlessness of their current systems could be improved.
