EPM Series: Providers, Follow these Best Practices to Optimize your Revenue
With the healthcare industry continuing to shift away from fee-for-service, healthcare organizations still face the challenge of properly tracking all their efforts and ensuring they are being appropriately reimbursed. A recent Healthcare Informatics report noted that:
“Ongoing changes in both public and private payment are shifting the landscape around revenue cycle management these days, and U.S. physicians and hospitals are facing considerable impacts on their healthcare reimbursement.”
The report also notes, that healthcare organizations are conducting procedures that are “more complex,” and so are the payments. Now more than ever, organizations need to be laser focused on their billing processes and revenue cycle. The ability to access data is obviously a key factor for success but transforming that data into a strategic plan to tackle revenue remains difficult.
The challenges around creating plans can come from a lack of leadership accountability, insight into performance metrics, transparency and progress tracking. These factors all play a role in losing sight of tactical actions that drive results. Critical data gets lost in various outlets within the organization which creates a gap between setting goals and achieving them.
Enter, Enterprise Performance Management, which offers a “closed-loop” system that organizations can use to combine robust data analytics with real-time action planning and progress tracking. Enterprise Performance Management enables organizations to clearly define, track and execute on strategic and operational objectives by empowering employees to track their day-to-day activities with the big-picture strategic plan in mind. For revenue, there are three potential goals to keep in mind:
- Increase point-of-service collections - Verify eligibility, confirm demographics and fully understand patient portions after insurance, so your registrars can collect payment prior to service.
- Understand denial root causes - Denials come from all parts of the revenue lifecycle. By linking denial trends to their origins, you can resolve errors and oversights that lead to payer rejections and denial write-offs.
- Monitor audit risk and reduce take-backs - Improving your financial health isn’t about finding maximum revenue. It’s about finding accurate revenue. By proactively identifying compliance risk areas, you can avoid revenue take-backs and track the audit appeal process.
Lessons Learned: A look back at the 21st Annual Compliance Institute
At this year’s 21st Annual Compliance Institute, compliance executives gathered to share insights and practical advice on common compliance challenges – from auditing and monitoring to privacy and security risks. Our partners from UT Southwestern (UTSW) Medical Center were selected to present their abstract, “Designing a Successful Analytics-Based Hospital Compliance Program and Securing Cross-Department Endorsement.” During their session, UTSW’s Kate Conklin, Chief Compliance Officer and Trissi Gray, Assistant Director of health system compliance, shared their knowledge on how automation, sophisticated algorithms and analytics played key roles in improving compliance within their organization.
At the conclusion of the conference, we connected with Conklin who shared her experience at the event, including trends and notable takeaways. Below you’ll find her feedback:
1. Were there any notable trends that you were surprised to see?
The most notable trend I found during the conference was a consistent message about the role compliance plays in establishing a culture for higher and more reliable performance across the organization. I was pleased to hear that this was a common theme amongst the keynotes and speakers that challenged Compliance Officers and other leaders to partner with the C-Suite to promote a foundational culture of compliance. I gained excellent insight into different methods for translating data into useful dashboards designed to educate the organization’s executive team.
2. What were your favorite parts of the event and what do you hope to see next year?
The keynote speakers were exceptional. I left the event feeling very inspired to elevate the importance of compliance and continue to advocate for automated analytics to lessen the burden. Next year, I hope to see more real-life examples from organizations that have faced significant challenges with a qui tam relator or non-compliance that resulted in serious penalty. I’m also looking forward to hearing topics that relate to leveraging data from hotline calls and other investigations to inform the institution about the work that is being done by the Office of Compliance. I believe this type of transparency is needed to encourage more reporting and strengthening of the organizational culture to ensure that their voice is heard and their concerns will be addressed.
3. Other post-conference takeaways that you’d like to share?
It’s always nice to network with your compliance peers. As compliance executives, we find ourselves in a unique situation, as we’re tasked to mitigate readmission, identify audit risk and find cost saving opportunities. However, when you hear so many compliance leaders share their best practices and tips, there’s a true sense of innovation and progress that empowers us all to continue leading the charge in improving our own compliance departments. In sum, it was one of the best conferences I have attended!
To read more about what Kate and Trissi discussed during their speaking session – such as manual vs. automated compliance monitoring and the importance of key stakeholder engagement – read highlights from their presentation, which were originally featured on the Compliance and Ethics blog. To learn more about how to act on your data and improve compliance, read about our revenue integrity solution.
Taking a Look Back - Our Top Webinars From 2016
At MedeAnalytics, we pride ourselves on acting as a resource for the health IT community. From case studies to webinars, we strive to provide our customers and the overall industry with the information they need to excel in the changing healthcare landscape. As we enter 2017, we are taking a look back and counting down our top three webinars from 2016.
3.) In third place is ICD-10 Analytics, which offered an overview on how to leverage data from peer organizations to execute CDI strategies. The webinar included insight from Trevor Snow and Adrienne Younger of Ardent Health Services. They both shared Ardent’s success story and explained how they were able to use our Revenue Integrity solution to identify documentation trends, pinpoint and address coding issues and more.
2.) In second place is Value-Based Contracting: Ease the Transition to Accountable Care. The November webinar highlighted how St. Joseph Hospital, part of Covenant Health, was able to use our Population Health solution to reduce their employee health plan costs in the first eight months of 2016. It also identified best practices that organizations can follow to efficiently transition to VBC.
1.) In first place is, Get Big Picture Insight into Your Revenue Cycle, which demonstrated how to leverage analytics to gain insight into the revenue cycle. The webinar highlighted how our customer, West Tennessee Healthcare, took control of their financial operations to improve AR days, reduce bad debt, understand denial root causes and more.
As we march forward into the New Year, we are excited to continue on as a go-to resource for the health IT community. Make sure to check back weekly for new blogs on pressing healthcare issues and the latest news from MedeAnalytics.
Looking to Improve Coding Documentation? Ardent Health Services Explains How
Despite a smoother than expected ICD-10 transition, accurate coding documentation still plays a critical role in ensuring financial success. By 2020, fee-for-value reimbursement is projected to represent 83 percent of revenue – up from 43 percent today.
Adrienne Younger, RN, CCDS, Manager of CDI education at Ardent Health Services recently connected with Kelly Gooch of Becker’s Hospital Review to discuss how Ardent achieved coding and documentation success by changing their coding culture, leveraging their own data and collaborating as a unified health system. Here’s a recap of the top takeaways from the discussion:
- Coders need to feel connected, vested and understand their new role in VBC – Adrienne underscores that “value-based care takes on a quality aspect that we've never really paid attention to or focused on.” She notes that it is important for healthcare leadership to educate coders and empower them with the necessary resources to understand the differences in fee-for-service and value-based care. Coders are no longer here just to code a record; they need to lookout for patient outcomes.
- Sometimes the best resources are right in front of you – For Ardent, one of the most valuable resources they were able to tap were their own records. Using MedeAnalytics Revenue Integrity, they could analyze their own data and find new insights under ICD-10. “Industry modules and resources are great, but what really makes the impact is when you use your own work to teach yourself,” explains Adrienne.
- Collaborate as a total health system – At the end of the day, everyone has the same goal: to improve patient care. In addition to having coders feel vested and connected to the clinical side, it is important that the entire health system works as a team. At Ardent, CDI worked with the quality team and attended case management meetings to understand how they can partner with each other. It’s these collaborations and relationships amongst everybody that help the entire hospital run as one team.
How West Tennessee Improved its Revenue Cycle with MedeAnalytics
Last week, Bart Teague, executive financial director of patient financial services at West Tennessee Healthcare, connected with Joe Goedert of Health Data Management. In the article, Tennessee health system seeks revenue cycle improvement, Bart shares insight on how the MedeAnalytics partnership has aided the health system in their efforts to improve their revenue cycle. Bart highlights how analytics has allowed them to do the following:
- Analyze 4,000 record reviews
- Find $3.7 million in refunds owed
- Win $900,000 in payment appeals
He also discusses what the organization hopes to gain through the continued partnership. In particular, West Tennessee plans to leverage MedeAnalytics’ solutions to improve revenue cycle workflows and develop a more centralized process as patients move through the system. Analytics will also allow the organization to assess the process of creating HIPAA transactions and ultimately, improve point of service collections.