Hayes' Healthcare Blog

Looking to Optimize Your Epic Revenue Cycle? Concentrate on These 4 Things

Posted by Karen Lilly Castle on April 5, 2017 at 9:00 AM

The healthcare industry continues to be in flux. The defeat of the Republican’s plan to repeal and replace the Affordable Care Act ensures that the status quo will continue. However, that status quo means a continuation of revenue reduction and pressure on margins. Meanwhile, the implementation of MACRA, the march to value-based care and a shift to alternative payment methods goes on.

All these factors ensure that revenue cycle optimization is more important than ever and organizations will continue to focus on plugging leaks, streamlining processes and implementing automations. Some of the biggest challenges include billing and collections errors, lack of claims process monitoring and insufficient staff training.

Epic’s end-to-end solution continues to attract new clients and is one of the fastest growing EHR applications in the industry. The comprehensive nature of the Epic solution makes it an attractive option, but the breadth of the platform makes it more critical that you ensure it is integrated properly in your organization. There are dozens of modules in the Epic offering, and they can sometimes be isolated in separate siloes. Without an effective integration plan, you may not see the results you need.

Focusing on these four key areas will help ensure you get the full benefits of your Epic solution.

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Topics: revenue cycle management, epic

Managing Denials in a Valued-Based Reimbursement World

Posted by Revenue Cycle Transformation Team on March 8, 2017 at 9:00 AM

Claims denials continue to be a thorn in the side of most healthcare organizations. The transition from manual to electronic documentation and billing has helped but denial rates still consume an average of nearly three percent of an organization’s net revenue annually. In recent years, denials have grown to encompass 15-20 percent of the billing value of total claims. That can mean a $6 million hit for a 200-bed hospital to over $260 million for an 1100 bed facility.[1]

And things don’t figure to get any easier. The switch from fee-for-service to value-based care will complicate billing even further despite new technology solutions. Value-based payments are complex and will undoubtedly lead to more denial issues.

Reducing revenue leakage due to denials is usually at the top of every organization’s focus list. Here are three things you can do to better manage your claims process and minimize denials.

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Topics: denial management, revenue cycle management

Payment Posting: A Crucial Link to Efficient Revenue Cycle Management

Posted by Sou Chon Young on October 19, 2016 at 9:00 AM

“For the want of a nail the shoe was lost,
For the want of a shoe the horse was lost,
For the want of a horse the rider was lost,
For the want of a rider the battle was lost,
For the want of a battle the kingdom was lost,
And all for the want of a horseshoe-nail.”

- Benjamin Franklin

What’s a horseshoe-nail story got to do with healthcare revenue cycle management? It illustrates that the smallest detail can ultimately make the difference between success and failure. In revenue cycle management, that detail is payment posting. Posting errors can lead to all the major revenue cycle issues: understated accounts receivable, mounting denials, false credits and inaccurate patient statements.

Payment posting has never been a glamourous position – considered a simple “heads-down” data entry job with little impact on the revenue cycle. If that was ever true, it certainly isn’t today.

The massive changes in the healthcare landscape have dramatically affected the professionals responsible for posting payments. Sophisticated new technologies, multiple new payment models and organizations transitioning from one billing system to another means today’s payment posters must handle a much wider range of scenarios.

The bottom line: take your payment posting operation for granted at your own peril. Here are some of the major new competencies you should be looking for in your payment-posting professionals.

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Topics: revenue cycle management, Payment Posters

The 21st Century Revenue Cycle Leader: 3 Key Factors for Success in the Evolving Healthcare Environment

Posted by Steven M. Wagner, PH.D., M.P.A, on August 17, 2016 at 9:00 AM

By Steven M. Wagner, PH.D., M.P.A, Executive Director Medical Practice Income Plan; Clinical Instructor in Health Policy, Finance and Administration, Department of Medical Education, Texas Tech Health Sciences Center El Paso at the Paul L. Foster School of Medicine, faculty instructor for Independence University, and Research Fellow at the Centers for Healthcare Research in the School of Advance Studies for the University of Phoenix.

Healthcare leaders need to look at the bigger picture of healthcare reform rather than narrowly focusing on its separate components. Fragmented legislation and grants led us to where the healthcare industry stands today, and only integrating networks of components in healthcare can lead us to successful reform. Success means that healthcare becomes accessible and affordable with or without insurance to all payors, quality outcomes take into account the functional and holistic health of the patient, and patients are satisfied and feeling well.

The hard reality is that in the end, everyone in the industry will be dealing with less revenue because the over-arching goal for the US government is cost containment. Only when leaders take all the changes into account will we, as an industry, be able to facilitate truly beneficial change. To make that happen, revenue cycle leaders need to be able to integrate cost, quality, and access into our routine processes of patient care, frequently analyze outcomes including the patients’ self-perceived health statuses, and develop actionable solutions.

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Topics: revenue cycle management, value-based care, Hayes Thought Leadership Blog Series

7 Ways to Plug High Deductible Health Plan Revenue Leaks

Posted by Paul Fox on August 3, 2016 at 9:00 AM

According to a recent report, three out of four employers now offer high deductible health insurance plans, up from just over two out
 of four five years ago.  At 22 percent of employers, it’s now the only option and nearly half of employers plan to make high deductible plans the only choice by 2018.[1]

high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher patient deductibles than a traditional plan. Choosing an HDHP is required if an individual wants to take advantage of the tax benefits of a health savings account (HSA/FSA). HDHP’s make employees personally responsible for a higher portion of their family’s healthcare costs, with the goal of motivating them to comparison-shop for medical services.

With an HDHP, consumers pay for all their medical services — at the insurer’s negotiated rate — until they meet their deductible. After that, consumers typically are responsible for a co-pay, normally 10 to 35 percent of the service — until they reach their out-of-pocket maximum. If payment isn’t collected at the time of service, the provider is left having to bill the patient for the remaining self-pay balances after a normal 20-40-day adjudication period. Most studies suggest the longer the self-pay account goes unpaid, the less likely it becomes that the provider will ever collect.

Can your organization survive under those financial terms? Most would answer an emphatic “no!”

There’s no question that HDHP’s are adding financial stress to healthcare organizations. Here are seven strategies you can use to help prevent revenue loss as a result of the growing use of HDHP’s.

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Topics: high deductible health plans, revenue cycle management, Healthcare insurance

4 Steps to creating super users for your system implementation

Posted by Susan Eilman on July 6, 2016 at 9:00 AM

In the world of healthcare technology, there are numerous system implementations occurring each year.  In order to make an implementation successful, it is crucial to develop your users into “super users” during the implementation process.  It is common for implementations to include and involve roles such as Project Managers, Practice (Operations) Managers, IT System analysts, and trainers, among others.  Each of these roles  have well defined parameters and expectations.  Often implementations involve super users, but this role is not always well defined and expectations are not always clear. 

A super user is your department’s champion for system knowledge and workflows. This person becomes your expert for the system implementation and teaches other employees how to use the new system features. Once you've identified your super users, you need to have clear expectations for this critical role. 

Questions should be asked early when selecting the super user.  Questions to consider include: Which user should you pick? What qualities should a super user have? How do you train them? Sometimes, you may pick someone that you feel is right for the job but turns out to be someone that is not quite fit for the role. 

Consider the following tips when choosing your super users for your next implementation:

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Topics: training, EHR, EMR training, revenue cycle management

3 Evolving Revenue Cycle Trends: Leveraging Them to Improve Financial Viability

Posted by Celeste Daye on March 23, 2016 at 9:00 AM

Celeste Daye, Senior Director Patient Financial Services, Dana Farber Cancer Institute

Healthcare finance executives from leading healthcare organizations like the Mayo Clinic, Kaiser Permanente, and the Cleveland Clinic have dubbed 2016 the “year of integration” for revenue cycle. They see consolidating complex revenue systems as the best way to reduce waste, increase efficiency, and improve the patient experience. One of the key aspects of such integration is involving the patient more in the financial aspects of their care.[1]

At Dana Farber Cancer Institute, the shift to value-based care, the evolving consumer mentality in healthcare, and a greater focus on clinical care plans are key changes impacting our revenue cycle. We not only recognize these fundamental changes, but are working to leverage them to benefit the organization.

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Topics: revenue cycle management, value-based care, Hayes Thought Leadership Blog Series, healthcare landscape evolution

Insurance carrier setup neglect: a costly oversight - Part 2 of 2

Posted by Angela Hunsberger on March 2, 2016 at 9:00 AM

In last week’s blog Angela Hunsberger outlined the importance of cleaning up the insurance carrier list to ensure efficiency to maximize payor reimbursement.  More than consolidating an old list, she explained the nuances of paper vs. electronic claim submission and suggested partnering with the billing team to tackle the list.

Continued in Part 2 of a two piece post, Angela provides an instructional roadmap detailing six steps of insurance carrier cleanup.   This article will provide the knowledge and tools needed to revamp carrier settings and revel in the financial payoff of a job well done.

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Topics: revenue cycle management, electronic healthcare information, Healthcare insurance

Insurance carrier setup neglect: a costly oversight - Part 1 of 2

Posted by Angela Hunsberger on February 24, 2016 at 9:00 AM

Insurance submission and processing has evolved over the past decade transitioning from printing paper claim forms to an electronic workflow. Adaptations include the NPI implementation, using a new standard paper claim form, sending more electronic claims as payors offer connections (or even refuse paper claims), moving to the ANSI 5010 electronic claim submission format, and most recently transitioning to ICD10. Considering those changes, along with the flurry of your other projects, have you audited your insurance carrier setup lately to ensure it is configured to maximize revenue cycle efficiency? By efficiency, I am referring to leveraging technology you are already paying for to get the most bang for your buck and maximize payor reimbursement.

Some people may think cleaning up the carrier list is a grueling meaningless chore and a waste of valuable time. On the contrary, the payoff is quick and it’s in real dollars and cents so you will want to reap the benefits by tackling the list at full speed. The outcome is not simply to consolidate an old insurance carrier list; it is much more dynamic than that. This blog, the first part of a two piece post, will explain what to look for and why. Read on my friend.

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Topics: revenue cycle management, electronic healthcare information, Healthcare insurance

Balancing Act: How to Effectively Maintain your Legacy System During the Chaos of an Install

Posted by Paul Allen on January 13, 2016 at 9:00 AM

Resources are limited, funds are limited, and time is invaluable. What should an organization do to maintain their legacy system during the installation of a new system?   It’s impossible to ignore the compliance, patient service needs, and required enhancements to your current system.   What should you consider to remain compliant? What can be done to make the go-live more productive and seamless? What are the tasks that can be completed to make the post go-live more productive? How does one provide the dedicated resources during this transitional time? With so many questions to consider, we have broken it down into four central topics so you can confidently maintain your legacy system during your install.

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Topics: EHR go live, EHR implementation, revenue cycle management

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