Revenue Cycle: Maintaining Stability Amid a Flurry of Change

Tim Kinney via HFMA

The challenges that many healthcare providers are facing in the revenue cycle are compounded by the fact that they are still in the wake of an electronic health record (EHR) implementation.  

“As we look around in early 2018, most hospitals, physician groups, and academic medical centers have selected their EHR systems, and they've invested significant time, money, and resources,” said Tim Kinney, managing director with Guidehouse's Healthcare practice. “But now we're at the point within the revenue cycle — and in the industry as a whole — where boards have approved and CFOs have championed EHRs, and CFOs are asking, ‘Are we leveraging the system? Are we getting any ROI? And beyond that, what type of automation can we drive out of this new system?’” 

Where We're Going

Several trends are emerging as healthcare providers explore ways to get more out of their EHR investment.

The call center approach. “There’s a shift on the front end toward a single patient touch, much like what is used in call centers,” Kinney said. The goal is to improve customer service from the first contact with the organization. Part of the reasoning behind this change is to increase efficiency, and therefore ROI. But it also is intended to improve patient satisfaction, which has become increasingly important with the onset of value-based payment. 

Developing revenue integrity units. With all the heavy-duty computing power that is now in place in their organizations, CFOs taking the lay of the land frequently are finding holes in the system. “Financial leaders are asking tough questions, like ‘Who’s protecting my gross revenue to make sure we’re capturing every charge?’ and subsequently, ‘Who’s making sure we’re getting paid all that we are owed?’” Kinney said. Until recently, few organizations took this type of unified proactive approach to ensure they were being paid the full amount to which they were entitled.  

“But with a large portion of revenue still coming from fee-for-service type arrangements, it is important for providers to make sure they are being reimbursed appropriately,” Kinney said. “So I think revenue integrity is a pivotal unit within revenue cycle, and we’re going to see it grow into a problem-solving function for hospitals and health systems.”

Automation. Tapping the capabilities of EHR systems to automatically process revenue cycle and other tasks has tremendous potential to boost efficiency. “How do I make sure that an account that's about to hit timely filing with an insurer goes to the top of the work list? There's functionality that can do that now automatically,” Kinney said.  

Many repetitive tasks in the revenue cycle are good candidates for automation, sometimes using robotic processing automation tools and sometimes through manual programming. Certain types of denials are well suited to automation. “Think about a claim that is denied just because it needs an explanation of benefits or something else that I don’t need a person to attach. I can go into the system, see that denial code, and write a script to automatically attach what’s needed and get it out the door,” Kinney says.

Digital follow up. The industry-wide push to implement EHRs has catalyzed a digital transformation in healthcare. Even now, patients commonly receive text messages, email reminders, and automated calls. They also are directed to patient portals where they can check coverage, make appointments, complete forms, set up payment plans, and more. The result, with a little luck: better communication and workflow, and more satisfied patients.

About the Experts

Back to top