Consultant Corner Podcast

A RCM Expert's Tips for Aligning Health IT with Financial Recovery

Thank you for visiting the Consultant Corner. Listen to our latest podcast episode and view the interview transcript below for Stoltenberg's recent discussion on strategically coordinating the business office, IT, and vendor systems to elicit hospital revenue cycle optimization.

Shana: Welcome to the Consultant Corner! I'm Shana Tachikawa, your host for today. In this episode, we're diving into healthcare revenue cycle optimization recommendations for hospitals and health systems with our expert Joncé Smith, Vice President of Revenue Cycle Management at Stoltenberg Consulting. Joncé, thank you for joining us. We're so lucky to have your expertise with us today. Could you share with our listeners a little about your role and healthcare RCM experience?

Joncé: Absolutely! I've been working with Revenue Cycle Management for over 20 years, and I've done a wide variety of projects – from new EHR implementations, to post-live optimization work, and full revenue cycle assessments to identify the root causes that have resulted in poor cash flow, low A/R collection and claims backlogs.

My focus at Stoltenberg is to ensure healthcare organizations are fully utilizing their EHR to its fullest potential and that their business office is running at its optimal level. Our revenue cycle management solutions are flexible. We fit them to each client's specific needs; we don't mold the client to our solutions. We work side by side with hospitals and health systems to improve their use of their EHR and how their staff completes each of their daily tasks.

Shana: Great, thanks so much for setting the tone, Joncé. According to a report from Kaufman Hall, health system finances will likely remain unstable across the next year, as more than half of hospitals are projected to have negative margins. That leads to my first question.

Shana: What are you seeing in the market in regards to hospital finance predictions?

Joncé: Hospitals and physician practices are still having a very difficult time right now. The cost to provide healthcare to patients has continued to rise which has further caused slim profit margins. With the 2% Medicare reimbursement sequester now extended through 2031, the outlook is tough and not what we had hoped for. Many hospitals still struggle with staffing shortages and broken supply chains.

Shana: What is a recommendation you have for hospitals navigating these challenging times?

Joncé: I think foremost, they have to focus on operational stability in regard to staffing and controlling costs, particularly in IT. Long-term staffing shortages in patient care areas can lead to burnout. Where staffing is short, a potential bottleneck can form, which can add an extra day to a patient's length of stay — and that only raises costs further. Patient onboarding and patient care workflows should be reviewed and modified, where needed, to ensure they're streamlined and efficient.

In regard to controlling IT costs, an area I see healthcare organizations overlooking is their list of applications. A close annual review should occur to ensure each application is fully utilized, and more importantly, to identify if there is any redundant functionality present. The failure to systematically and correctly sunset a legacy application, along with all its supportive environment (servers, interfaces, associated peripheral hardware, etc.), can cause an unneeded and unwarranted IT expense.

Shana: Very helpful. With that, let's get into a deeper dive of the initial (and often forgotten) portion of the revenue cycle. What is a best practice to improve the front end of the revenue cycle?

Joncé: Baseline your overall registration process with a supercharged focus on capturing correct patient insurance information! Nothing derails the revenue cycle faster than a poorly managed registration process. Spend the money to hire and train strong, capable registration staff, and it will easily repay an organization over tenfold. Twenty additional minutes spent on the front end to obtain clean, accurate insurance information will save at least six hours over the remainder of the revenue cycle. Your charge edits will be correct and accurate for the right payer, which will decrease denials, and your outstanding A/R will be lower because primary claims will be paid faster. This in turn will increase your cash flow and give business office staff the time they need to work appeals and resolve the other tough problems they should be focused on, instead of trying to run down correct patient insurance information.

Also on the front end, run payer eligibility twice — once before the patient presents to know if the visit will be self-pay or not, and then run it again at the time of patient registration. Absolutely be sure to capture ID cards and all insurance cards. For hospital pre-admits, run estimates for what the care will cost prior to admission, since no one likes a surprise bill!

Clean registration data is absolutely vital to start your revenue cycle off strong. I also advocate capturing patient insurance data when staff book the appointment. Yes, it takes time to do this, but it saves time, effort and dollars. The charges will post cleanly, and claims will generate with fewer edits. It's a total waste of time to run charge edits and generate claims when you have an incorrect payer listed on the account.

Shana: So much of your project oversight seems to help bridge the gap between IT and the business office. How can hospitals better align the two departments to eliminate data, project, and communication silos?

Joncé: Well, it takes work and dedication! You have experts in the business office, and you have IT experts, but unfortunately, they don't always speak the same language. So, I consistently drive discussions between the two to foster an environment where each side shares its knowledge.

When an issue is identified, I'll first discuss it internally with just my IT team. We'll talk through the issue and its ramifications on patient care or billing to understand its severity. I'll then ask my team for suggestions on a resolution and next steps. If I don't hear within the resolution steps a plan to call the business office team who opened the issue, I ensure it's added. I consistently drive for communication between my team and the other team. It not only allows an opportunity to learn from each other, it also sets precedence that my team will work with the business office — our internal client — to fully resolve an issue.

And just a word here on email. Email is wonderful, but it isn't an end all, be all, especially in regard to good communication in remote and hybrid models. A simple phone call to speak directly one on one with the other team can greatly reduce silos. To achieve the best results on IT projects, all teams need to work together.

Shana: As the industry grapples with turbulence, Stoltenberg's Revenue Cycle Check Up program offers a 12-point financial health assessment for hospitals and health systems. Could you give an example of how the RCM Check Up has helped a client?

Joncé: Our 12-point financial health assessment tool provides a fast ROI because it quickly pinpoints which area within a client's revenue cycle needs correction. This is especially vital for healthcare organizations amid ongoing financial recovery efforts industry wide. A recent client with a 300-bed community hospital contacted us to help them because their Days in A/R was too high, and they were experiencing poor cash flow. We worked with them and analyzed their financial data and workflows to quickly set them on a new course for significant improvement in both values.

Shana: What were the assessment outcomes that proved ROI?

Joncé: Within 45 days of deploying our correction strategies, they reduced their Days in A/R by 18%, which initiated improvement in cash flow. By deploying a new streamlined workflow for claim generation developed specifically for the hospital system, we were also able to cut their claim generation lag by two full days. That two-day savings to get claims out the door faster to payers elicited an immediate boost in their cash flow.

Each correction strategy is tailored to the specific client healthcare organization, while our recommendations for improvement are based on our revenue cycle knowledge and industry experience. Our goal is to deliver a strategy that can be sustained by the client's staff long after the project is completed — an optimal win-win outcome.

Shana: Oftentimes in your role, you serve as a liaison and client advocate on behalf of hospitals. What is the biggest RCM-related frustration you've seen from hospitals toward their system vendors?

Joncé: Vendors not realizing the full adverse effect their work can cause to a hospital's revenue cycle. I spend a lot of time educating vendor teams about financial applications and how they work. I consider it part of my job. It's part of the give and take that's required to build a strong working relationship with another vendor. In particular, there are two scenarios that come to mind in regard to this.

First, is how normal, routine system maintenance can cause a big disruption on the revenue cycle. Most vendors do not realize a revenue cycle system doesn't have an off or quiet time. RCM systems run 24 hours, seven days a week throughout the year. Even on Christmas, there are always charges being posted, edits firing, claims generated, file transmissions, and payments coming in. We know systems have to be maintained and updated, but healthcare leaders must select maintenance dates with downtime with care. Don't schedule any maintenance during month-end run dates. That's when your system is running at its peak load! When selecting a start time for maintenance, keep the timing of day-end flows in mind, with careful attention to your claim generation step. Healthcare facilities need that fully complete before any maintenance starts. If not, healthcare organizations can easily add an extra day to the claim generation cycle, which translates to an extra day in A/R that is completely avoidable.

Secondly, when a hospital or health system has issues that require vendor assistance for resolution, clearly communicate the effect on your revenue cycle. Technical vendor teams do not always understand the waterfall nature of the revenue cycle and how quickly a single issue can balloon into a big problem that causes a disruption in your facility's cash flow.

Shana: How can they strategically address or resolve this?

Joncé: The best working vendor relationships are built on clear expectations built by consistent, transparent communication. Establish a set meeting schedule to review outstanding issues, discuss upcoming work, and maintain, at a minimum, a three-month out calendar. This allows adequate time for both teams to plan, prepare and work through any obstacles. Work hand in hand with system vendors on turnaround and resolution. Provide detailed documentation on the issue, and explain its effect on your revenue cycle. Review the issue's status at least every other day to ensure constant progress is being made. Review your contractual SLAs and escalate to the vendor's management team if needed. These are key points to building an effective, working vendor relationship.

Shana: One-third of healthcare CIOs deemed patient engagement as a top industry focus for the year, according to the 10th annual HIT Outlook Survey. How can health systems improve the patient experience in terms of the revenue cycle?

Joncé: For patient scheduling, check each provider's schedule to ensure there are two new patient appointment slots open every month. Ensure a new patient can quickly book an appointment and be seen. Then, go one step further and ensure each provider of this same group has two established patient appointment slots open each week. You don't want to turn away any of your current patient population when they have a need. To not have an available open slot for either of these two groups conveys to those patients they're not important.

Review the patient onboarding process and your inbound workflows to identify where they can be improved. Did you provide an appointment reminder text message or call? How easy is it for patients to sign in? When the patient presents at the front desk, is their insurance and billing information politely reviewed in a private and efficient manner? Was the patient called back to see the provider within 20 minutes of appointment time? This is the heart of the patient engagement experience and these impressions go farthest in making a patient feel valued.

When a patient checks out, how quickly is the process completed? Are patients being told what to expect in regard to the billing for the visit? Are staff asking the patient if they have any questions or concerns? Again, these may seem like small things, but they speak volumes to a patient who may not be feeling well or to someone who's a little anxious over the visit.

Finally, if a patient calls about their bill, make it as painless as possible to quickly get them correct answers to their questions. That means phone call trees should not require more than a total of three steps to speak to the right person. Ensure this staff group has completed and reviewed customer service training.

Shana: Finally, what is an overlooked mistake healthcare organizations are often making right now that leaves money on the table?

Joncé: On commonly overlooked mistakes, I'd say right now, consider patient payment plans. With the economic slowdown we are now in, be proactive and offer a patient payment plan for slow paying accounts with a high outstanding balance. Your patients and your organization may come away with a win-win.

My last recommendation is for all healthcare organizations to be vigilant and identify areas where they can continue to improve. Encourage an environment where a continual improvement process is the norm. From a revenue cycle perspective, consistently run statistical metrics and review your organization's performance. Question and identify emerging trends and reward positive gains when staff are attaining a goal.

Shana: Absolutely, create a culture of ongoing improvement! That seems like a perfect place to close, as that's all the time we have in today's episode of the Consultant Corner. Thank you, Joncé, so much for your time and expertise in our discussion of healthcare revenue cycle management.

To submit a revenue cycle optimization question to Joncé, email us at stoltenberg@stoltenberg.com, and stay tuned for future health IT insight from the Consultant Corner.