Helping Your Health IT Clients Prepare For Coming Revenue Cycle Changes

By Megan Williams, contributing writer

The healthcare industry has been so deeply focused on EHR (electronic health records) and associated government programs, that many areas essential to organizational well-being have gone overlooked.

One of the most important is revenue cycle, and with some of the changes coming down the industry pipeline, few of your clients can afford to keep their heads in the sand.

Predictions And Response From HIMSS

HIMSS hasn’t forgotten about the importance of Health IT (HIT) and revenue, and in response to some shifts in the healthcare industry, released this white paper, “Rethinking Revenue Cycle Management,” through its Revenue Cycle Improvement Task Force in April.

The paper names several specific forces facing the industry that will directly impact the revenue cycle management process. These include:

• Falling payer reimbursement rates
• Regulatory changes
• Growth in consumer payments
• Shifting consumer expectations

It also highlights a previous attitude toward revenue cycle technology that effectively amounted to “bolting on” solutions and reworking internal processes — an approach that will not suffice in the future and can even lead to unintended complications and increased costs around the revenue cycle process.

Perhaps the most important takeaway from the paper is the need for a shift in focus from one around business to that of the consumer: “Historically, healthcare providers have designed their revenue cycle systems and processes around business-to-business relationships to communicate with, and collect payments from, government and commercial healthcare insurance companies. Consumer payments have been a secondary, although important, consideration. This approach made sense when the consumer represented approximately 13 percent of the $2.1 trillion in payments made to providers, as was the case as recently as 2013. By focusing on business-to-business payments, the healthcare industry could achieve a greater efficiency and drive down its cost of collections.”

Moving Forward With Technology

More than ever before, tech and data will be integral in composing a truly effective and integrated revenue cycle process.

HIT Consultant has recently addressed the issue, with a list of suggested technology solutions that will help ease burden on administration, and host all back office requirements with little effort on the part of your clients. These solutions include:

• proactive outstanding claims work queues
• charge entry import that’s flexible
• CCI/LCD edit scrubbing that works in real time
• clearinghouses that are fully integrated
• proactive outstanding claims work queues
• financial reporting dashboards that are robust and work in real time

Going Deeper

To read up on the insights your executive contacts will appreciate, please read, “Could The C-Suite Benefit From Revenue Cycle Management Software?”