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Developing a Robust RCM Strategy in an Evolving Payment Landscape

September 28, 2017
by Heather Landi
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Third, healthcare organizations need to develop some commonality of technology. “For a health system now, they have four different bolt-on systems, at various sites, that are supposed to be feeding to one place, but they don’t. If you’re going to decide on a particular utility, it has to be able to scale with how you, as an organization, are scaling. If you take the concept of best-of-breed, if they are not interoperable with your revenue cycle, if they just produce different kinds of things that somebody on the back end needs to put together, then that doesn’t work,” Sanderson says.

Broadly, Unell contends that healthcare organizations need to view revenue cycle as a strategic, value-added function and a differentiator. “Organizations historically look at revenue cycle as a cost-focused, transactional operation,” he says. “We believe here, and we’ve invested in it in the past five years and it’s paid dividends as far as our employee engagement, our turnover rates as well as our financial outcomes, that if you invest in it and approach it as a strategic function and something that can add value, it will.”

Leveraging IT and the Role of the CIO

Healthcare organizations and payers are increasingly leveraging IT tools to make revenue cycle functions more efficient and to reduce cost. “On the short-term horizon, we see a drastic integration of automation, or what we call RPA, robotic process automation, that’s going to take a lot of the core tasks of account follow-up and related things, rote tasks, and those are going to be automated. And those are the things that we’re working on now, that we see the responsible parties for RCM most interested in, because that’s going to decrease costs,” Sanderson says.

Wolfskill agrees, adding, “Commercial payers want more automation. The biggest movement we’ve seen in the past 12 months is a willingness to move ahead with electronic processing for pre-authorization for service. More recently, we’re seeing a lot of movement on the payer side, as well as the hospital side, to move information back-and-forth electronically.”

At Piedmont, senior executive leaders are placing more value on integration rather than best-of-breed technology systems, Unell says. “Historically, we had best-of-breed technologies; we had over 75 systems with ICD-9 codes in them. When preparing for meaningful use and ICD-10, we made the decision to do a change out. We realized integration is more important and we’re trying to leverage Epic to help us cross those silos, have a single source of truth and leverage analytics out of the system,” he says.

And, in the midst of all this work, there is an opportunity for collaboration between the CFO and the CIO to better leverage IT to support revenue cycle performance, industry leaders say. Wolfskill notes, "CIOs need to be engaged with the CFOs and understand the automation and technical resources that are out there to eliminate manual work, within a number of areas of finance, but especially within revenue cycle management. Where can things be automated beyond where they are today?" Wolfskill asks. “If the technology is not available within the core processing system that the hospital or system is using, is there a bolt-on that will solve this issue and let me automate and be much more effective and efficient in how I process activities within the revenue cycle?”

Sanderson also contends that data science will transform the revenue cycle. Since many revenue cycle positions are transaction-oriented, and the data is present to make accurate artificial intelligence predictions, there is an opportunity to use machine learning to resolve revenue cycle issues. 



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