ICD-10, collections top revenue cycle concerns

Experts at the Revenue Cycle Solutions Summit highlighted the promise of front-end process improvement for point-of-service payments, patient eligibi
By Richard Pizzi
08:05 PM
stethoscope on money

Revenue cycle leaders have a lot to focus on, but expert panelists at the Revenue Cycle Solutions Summit on Sunday said point-of-service collections and the looming ICD-10 switch rank among the top challenges facing those departments in 2015.

“Improving processes on the front-end of the revenue cycle is essential,” said Robert Wagner, senior director of revenue cycle at Nebraska Methodist Health System during a Revenue Cycle Roundtable held prior to HIMSS15.

Wagner said that a “front-end” emphasis encompassed issues like point-of-service collections, determining patient eligibility for financial assistance and ICD-10 preparation.

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“We’ve launched a patient estimation tool to improve our POS collections, and by improving POS we can better identify patients in need of financial assistance – which is a source of patient satisfaction,” he said.

Cherilyn Warner, revenue cycle director at Holzer Health System, echoed Wagner, saying that moving patient eligibility information to the front end of the revenue cycle is a central strategy.

“We have built the collection of copays into the budget expectation of every department, every year,” she said during the same roundtable. “Accurate patient responsibility information is crucial because patients and payers are very conscious of price awareness.”

Front-end collections have acquired increased importance, Wagner said, as inpatient volumes have lost ground to outpatient procedures during the great recession.

Preparation for the ICD-10 transition was also top of mind for panelists.

“We’re trying to determine our overall exposure and do contingency planning,” said Lori Szymonowicz, senior director of patient financial services at Jefferson University Hospitals in Philadelphia. “We have put a lot of emphasis on our clinical documentation initiative program. We do expect more denials, and we intend to watch the claims closely to make sure we haven’t lost ground.”

Wagner said Nebraska Methodist has designed a “lean team” to manage the denials process after the ICD-10 transition. But the health system still expects a decrease in cash flow, at least initially, after Oct. 1. “Our finance team is setting aside cash to carry us through,” he said.

The panelists confirmed that healthcare revenue cycle teams understand the industry’s move toward value-based reimbursement models. Indeed, according to Szymonowicz, in many health systems there is “hand-in-hand preparation between finance and clinical teams” for a value model.

Melanie Hennessy, director of accounting shared services at Walgreens, said companies like hers are preparing for value-based reimbursement by partnering with health systems to become part of accountable care organizations. “We think we can offer value to both patients and providers under a value-based model,” she said.

Wagner said his health system believes in the importance of developing relationships with “non-traditional” care providers, like Walgreens, because it helps the health system determine if care is offered in the right environment.

“There is increasing pressure to provide care at the appropriate level and at the appropriate location,” he said. “It’s important to comprehend this because under value-based care you have to get it right to get paid.”

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