Hayes' Healthcare Blog

Developing a Revenue Integrity Program? Get Help with the Right Partner

Posted by Vasilios Nassiopoulos on May 10, 2018 at 9:00 AM

You’ve been struggling with the need to improve your bottom line while reducing organizational costs. New financial models, increased cost shifts to patients and continued merger and acquisition activity are leading to an increased focus on your organization’s overall financial health. Up until now, you’ve likely relied on revenue cycle management (RCM) which has served you well, but you now recognize that RCM doesn’t go far enough. You need something more, so you’ve decided to implement a more holistic revenue integrity program.

Revenue Integrity – getting paid for everything you do, and keeping it – takes a broader view of the organization’s revenue stream. A revenue integrity program evaluates many of the same people, processes and technology as RCM, but goes a step further by understanding how these various disparate processes can be connected to optimize the entire revenue cycle.

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Topics: revenue integrity, vendor selection, Change management

Revenue Integrity Leaders Gather to Find Solutions to Healthcare’s Financial Challenges

Posted by Peter J. Butler on May 2, 2018 at 3:00 PM

By Peter Butler, President and CEO, Hayes Management Consulting

As part of our commitment to helping healthcare organizations optimize their business processes to achieve greater revenue integrity, Hayes has recently formed a Revenue Integrity Advisory Council (RIAC), a small group of revenue cycle and compliance executives who understand the real-world financial challenges associated with running a large, complex organization. We held our first meeting on March 20th in Chicago, where leaders from some of the nation’s most prestigious healthcare organizations gathered for an afternoon to discuss issues, exchange ideas and develop new solutions for overcoming some of their most pressing concerns.

So what was on their minds? Not surprisingly, the topics covered a range of issues including telehealth, quality-based reimbursement, and high-cost drug reimbursement, as well how to organize the coding function and managing compliance issues.

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Topics: Revenue, revenue integrity, Hayes Thought Leadership Blog Series, Thought Leaders

11 Ways to Make Sure Your Contract Management Process is Meeting Your Organization’s Needs

Posted by Margaret Webb-Nolan on April 5, 2018 at 9:00 AM

Managed care contracts make up a significant amount of a healthcare organization’s revenue stream.  The impact these contracts can have on your top and bottom lines makes managing them appropriately one of your top priorities. Those organizations that have realized this and have an effective, efficient contract management process in place have a reasonable upper hand over those that don’t.

Staying on top of your managed care contracts is critical to maintaining a sound financial foundation. Managing these contracts successfully can help drive additional revenue through new insurance products. Properly handled managed care contracts can also increase patient satisfaction by enabling patients to obtain the treatment they need.

If you have challenges in keeping track of and managing your contracts, you are not alone; it is an all too common problem in hospitals and healthcare organizations across the county.

Here are 11 things to consider that can help you develop and administer a successful contract management process.

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Topics: Contract Management, Revenue, Managed Care Contracts

8 Tips to Help Understand and Avoid Denials

Posted by Susan Eilman on March 29, 2018 at 9:00 AM

Are you drowning in claim denials and rejections?  Are your denial rates high? It is inevitable for healthcare organizations to experience denials in today’s complex billing arena. Industry standards for denial rates are between 5-10 percent.  If your denial rate is above 10 percent, then "Houston you have a problem!” It is time to build a strategy to reduce your denial rate.

Claims denial avoidance processes should be proactive but in most healthcare organizations, they are more reactive. It is important to be proactive from a revenue integrity perspective at the front-end, and accurately collect and report patient and insurance information before or at the point-of-service. There are ways to be proactive from the billing side as well.

As you develop your action plan, it’s important to define your terms. You and your staff need to understand the difference between a claim rejection and a claim denial.

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Topics: claims denials, reduce denials, denial management, Revenue Cycle Health

Forgotten A/R: 3 Steps to Getting Beyond “Low Hanging Fruit”

Posted by Paul Allen on March 21, 2018 at 10:34 AM

Low hanging fruit. You likely hear the term nearly every day in the business world. It refers to something easy to reach and therefore should be “picked” first. It has also come to mean an area where you can concentrate your efforts to get the most results.

In healthcare finance, low hanging fruit is often used as a descriptor of the easiest money to collect on outstanding accounts receivable. Revenue Cycle teams focus on Medicare, Medicaid, and specific major payers that make up the majority of their revenue.

Working the payers that will yield 80 percent of your revenue – Medicare, Medicaid, and two or three of your major commercial plans - makes sense and should be the first line of attack when looking to collect outstanding revenue. But what about the “fruit” that is further back and higher up in the “trees?” What about that other 20 percent of your revenue?

You shouldn’t be content with disregarding 20 cents of every dollar. With improvements in automation and technology, it’s time to take another look at this still-very-valuable component of your receivables and begin mapping out a new attack plan to collect it.

 

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Topics: revenue integrity, A/R management, Revenue Cycle Health

6 Questions to Ask When Preparing for a Legacy System Retirement

Posted by Clinical Transformation Team on March 14, 2018 at 9:00 AM

Organizations about to undergo an IT systems transition must develop a comprehensive task list to ensure the project is successfully completed. However, one of the key aspects of the conversion is sometimes overlooked: how is the retirement of the legacy system to be handled. The legacy system being replaced still must be up and running and properly maintained to ensure it services the needs of the organization during the implementation. Failure to include a plan to make that happen can have serious negative consequence in terms of efficiency and productivity. It can also affect patient care if clinicians aren’t able to rely on the legacy system to do their jobs during the transition.

As you prepare for your implementation and legacy system retirement, here are six questions to ask to help you develop your plan.

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Topics: Legacy System, legacy retirement, healthcare planning

3 Keys to Staying on Top of Your Underpayments

Posted by Aaron Wall on February 14, 2018 at 3:29 PM

Research from the Medical Group Management Association (MGMA) estimates that payers underpay practices in the U.S. by an average of 7% – 11%. In a time when budgets are tightening and reimbursements are shrinking, it’s more important than ever to make sure your organization is being paid correctly. Some organizations take this seriously but many don’t spend nearly enough time focusing on underpayments and their bottom lines suffer as a result.

Forward looking healthcare systems that are committed to a robust revenue integrity program, take the time to analyze their revenue and reimbursement details. Based on their success, it is clear that it’s worth the time and effort each year to make sure your contracts are up to date and that that you are monitoring your underpayments on a regular basis.

Staying on top of your underpayment activity is not as difficult as it may seem. There’s a good chance someone at your organization already has the information needed to get this ball rolling.

Here are three key things you need to implement an effective reimbursement analysis program.

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Topics: revenue integrity, Revenue Cycle Health, Data Analysis

5 Benefits of Staff Augmentation during Your System Transition

Posted by Clinical Transformation Team on January 31, 2018 at 9:00 AM

The project list for a transition to a new EHR or practice management system can seem endless. But even with a lengthy, comprehensive task list, one key component of a system transition is often overlooked. How are you going to support your legacy system during the implementation of your new system? Despite regularly being ignored or discounted, developing a plan for legacy system support is one of the most important things you can do in your transition planning.

The default for too many organizations is to try and use existing FTEs to handle both legacy support and new system implementation. As it often turns out, however, this can be a flawed strategy which leads to reduced efficiency in current operations, increased errors and costs, surge in user and staff frustration that in some cases can lead to significant employee attrition.

As revenues shrink and margins tighten, chances are your resources have already been reduced. Asking your already overworked staff to assume more responsibilities without expecting a negative impact is unrealistic. Those organizations that understand this problem up front address the issue by augmenting current staff with temporary help. In many cases that takes the form of either managed services to handle the help desk or adding resources to help take on other legacy support duties.

Here are five benefits of staff augmentation during your system transition.

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Topics: system transition, staff augmentation, clinical optimization

Texting Patient Information? Yes, As Long as You Take These 3 Steps

Posted by Cristina Randall on January 17, 2018 at 9:00 AM

To text or not to text. That is the question. When it comes to personal interaction, there is no doubt that texting has become an essential form of instant communication between friends and colleagues.

Texting and secure messaging are also beginning to transform healthcare delivery and helping to improve quality, provide access and control costs. But up to now, questions surrounding the permissibility of texting in a healthcare setting has proven to be a somewhat murky conundrum for providers.

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Topics: patient information, healthcare privacy and security

3 Key Planning Steps to a Smooth IT Transition

Posted by Tracy Welsh on January 10, 2018 at 9:00 AM

Proper planning prevents poor performance. The Five P’s may sound trite and cliché, but that doesn’t make it any less accurate. It’s especially good advice when you are about to go through an IT transition.

The upheaval in the healthcare industry is creating an unprecedented number of IT changeovers because of provider and vendor mergers and acquisitions, or the need to upgrade to meet the requirements of the Affordable Care Act (ACA) and MACRA. In 2017 alone, nearly 50 health IT companies and over 40 healthcare organizations have been involved in a merger or acquisition.[1],[2]

Even if M&A activity isn’t on your immediate horizon, there is still a serious likelihood of change. The number of clinicians replacing their EHRs has increased 59 percent since 2014.[3] Nine percent of acute care facilities and 11 percent of ambulatory facilities are looking to replace their current EHR.[4] Half of large hospitals were planning to replace their EHR systems as of 2014.[5]

Implementing a new EHR or practice management system while maintaining current operations on the legacy system can pose significant challenges. The best way to overcome the obstacles you will face is by laying out a detailed plan before you start. Here are three key steps you should consider as you prepare for your transition.

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Topics: system change management, clinical optimization, it transition

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