1. How is the RoundTable approach to RCM different than its competitors? Leveraging our depth of RCM and IT experience, RTSS customizes solutions based on our client’s needs. This includes people, process, and technology. We tailor these three integrated approaches to drive sustainable improvements in any area of your Revenue Cycle. With over 25 years of Revenue Cycle experience, our consultants have worked in prestigious & financially successful medical systems affording us the opportunity to learn from the best and pay it forward. Over the years we have learned what works and what doesn’t, thus creating our own catalog of Best Practices. As an RCM partner, we share these Best Practice solutions with our clients and offer elbow to elbow support to drive change and deliver exceptional results. 
2. What have been some of the challenges to implementing a robust RCM operation in health systems and hospitals today? While there are many challenges to share, a long-standing obstacle is the disconnect between various departments of the revenue cycle including clinical departments. The potential impact to the revenue cycle begins when the patients account is registered. Every caregiver who interacts with a patients account can make a difference. Registrars create and update patient accounts with insurance information, clinicians are responsible for documentation quality which impacts charge capture, clinical department leaders are responsible for charge reconciliation to identify and capture missed charges, coders assign proper procedure and diagnosis codes for claims, billers resolve payer specific edits and prepare claims for submission, follow up specialists intervene when payment is delayed. Denials specialists fight for reimbursement and payment posters record the payments when received. The entire process from front, middle to end, is integrated. Oftentimes departments lack an understanding of this connectedness as well as their overall impact on the revenue cycle at large. This creates silos and many times can restrict efficiency. With shrinking profit margins and the implementation of the “do more with less theory”, revenue cycles must have a proactive & integrated approach to protecting its reimbursement. This means every caregiver must understand their place in the revenue cycle and adopt the “I make a difference” mindset.
3. How have revenue cycle operations changed over time? Revenue cycle operations is constantly adapting to change. Movements such as EHR implementation or upgrades, hospital mergers, acquisitions or expansion, new reimbursement models and ever-changing payor policies have certainly changed the operations landscape over the years. This environment of rapid change has forced organizations to be nimble and adept at change management.  
4. How important is it for a hospital/ health system to be proactive about their revenue cycle management– for instance, by using data analytics to predict patient behavior, and cut losses? (https://www.beckershospitalreview.com/finance/rcm-tip-of-the-day-use-data-analytics-to-predict-patient-behavior-cut-losses.html)  Being proactive about RCM isn’t just important, it’s mandatory. It’s the revenue cycle “preventative care” philosophy; acting now to prevent revenue cycle “sickness” in the future. A healthy revenue cycle is informed and prepared for potential pitfalls. For example, the OIG posts its upcoming target review areas on its website continuously. Staying in tune with their audit initiatives allows providers the opportunity to review these targeted areas and address any findings, before they land in the hands of the OIG. Additionally, staying abreast of payer behavior limits the risk of increased denials and/or potential write-offs. Using data analytics, hospitals can diagnose issues, predict outcomes and initiate enhancements. There are a variety of ways a revenue cycle can be proactive.  
5. What does the future of RCM operations look like? What should health systems be mindful of? As new reimbursement models evolve and expand, healthcare organizations will need to proactively assess and adopt the necessary internal workflows required to maximize reimbursement under such models.  Additionally, we have moved into an environment of pricing transparency. Payers in some states are promoting financial incentives to members when they shop for healthcare. As a result, patients are becoming educated and savvy consumers. While payers and market competition may drive patients towards care at a lower price point, providers will need to develop strong and lasting relationships with their patients, promoting value over cost.

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In this first issue, we review several lessons learned on how laboratories must capture all available revenue and at a lower cost, even with continued reimbursement compression, due to PAMA (Protecting Access to Medicare Act) and payor contractual reductions.

Top Five Diagnostic Laboratory Lessons Learned on How to Accomplish This Include:

1. Automation is key to obtain accurate and timely information to create, transmit and receive payment for clean claims and reduce costs.

2. Alerts and data requirements “stops” built into not only the RCM billing and financial software, but more importantly, the laboratory order entry system to capture demographics, insurance, requirements and payor guidelines at the front end of the process.

a. Comprehensive, real-time eligibility and benefits– to obtain the correct and relevant insurance information for each patient and each encounter

b. Pre-authorization- in the last two years, laboratory pre-authorization requirements have increased substantially. If payor requirements and authorization approval is not captured prior to the test being processed and results released, it is too late

c. Consistent communication with ordering providers with Pre-Authorization guidelines and needs are an important part of this process.

3. Payor Contract review and re-negotiation– Payor contracting is a challenge for laboratories, which is driven by large laboratory competition as well as industry reductions. The past, traditional contract philosophies, based on a percentage of “current year” Medicare allowable are no longer sustainable with PAMA reductions of 10% per year beginning 2018.  The PAMA data collection and rational is being challenged in the courts, but the current reimbursement decline continues. Laboratories need to review and re-negotiate with payors based on a defined fee schedule.

4. Patient Collections – The patient’s responsibility percentage continues to increase each year. With a laboratory industry average bad debt percentage of 10-12%, this loss of revenue now becomes significant.

5. Focus and Tools – must be in place to capture this revenue more efficiently.

Some examples to assist with the capture of this revenue are:

a. Secure websites for patients to access current balances and pay online

b. Digital link to statements available via email and or text

c. Outbound automated dialer systems for payment reminders

d. Call center availability. The personal touch and availability of someone to answer questions is still important. There are still many patients that are concerned about payments via technology, you do not want to lose the revenue due to the non-availability of individual representative.

Lessons Learned: Diagnostic Laboratory content was provided by Jan Gunter, one of RoundTable’s Senior Revenue Cycle Interim Leaders, who has been an integral part of team for the last year. Jan has worked in the healthcare industry for over 30 years, 17 of which in leadership roles for nationally recognized organizations. With a primary focus on Revenue Cycle Operations, Revenue Integrity and CBO/SBO implementations, she blends strategic initiatives and business philosophy with industry standards and solution-based methodology tools to improve financial results for clients.

Her expertise in EMR/Software applications and regulatory knowledge provides our clients an excellent resource for implementing operational improvements and strategies significantly impacting cashflow positively.

Recently, Jan worked with a client implementing a Denials Management program in conjunction with design and implementation of their operations and workflows. She developed benchmarks and metrics to guide leadership in monitoring financial and operational status, long term. The outcome of this project showed measurable decrease in AR by an average of 27.5 days across the organization by means of cash collections, operations and technology efficiencies, not through write-offs.

The post Lessons Learned: Diagnostic Laboratory appeared first on RoundTable Strategic Solutions.

According to the National Association of Healthcare Revenue Integrity, “the basis of revenue integrity is to prevent the recurrence of issues that can cause revenue leakage and/or compliance risks through effective, efficient, replicable processes and internal controls across the continuum of patient care, supported by the appropriate documentation and the application of sound financial practices that are able to withstand audits at any point in time.”

But people often think about Revenue Integrity quite differently from this “cut-and-dried” definition. In fact, it’s become something of a hot topic. Some people think it’s simply a department that maintains the Chargemaster. Others view it as a more robust cross-functional team with insight and knowledge of the entire revenue cycle. As subject matter experts, they can identify and resolve gaps that cause revenue leakage. Here, at RoundTable Strategic Solutions, we view Revenue Integrity as a program, strategy and department focused on eliminating revenue leakage and maximizing reimbursement.

Several market trends have been influential in formulating our paradigm on Revenue Integrity:

• As of January 1^st, hospitals were required to publish their Chargemasters. Many were concerned about the implications of this transparency.
• As such, there has been an increased focus on CDM pricing. Hospitals became focused on setting their prices to be market competitive while continuing to maximize reimbursement. Some recruited vendors to assist while others managed this review internally.
• Likewise, we see that today’s market is experiencing an abundance of change and opportunity.
• Telemedicine services are on the rise.
• Population health and value base care are expanding.
• Driving down cost is becoming a mandatory effort and the overall patient experience is getting an abundance of attention.
• Data analytics, EHR optimization and denial prevention are also a primary focus.

What is included in a Revenue Integrity Program?

Although key components can be tailored by client, Revenue Integrity typically encompasses functions such as CDM maintenance, charge capture and recon oversight, edit resolution, and department/provider outreach. CDI and denial management can also reside in a Revenue Integrity department. Regardless of how you think about it, Revenue Integrity is an integrated team of highly specialized members with broad knowledge of the Revenue Cycle. They are focused on process improvement surrounding charge capture, denial prevention, revenue maximization and compliance.

How to build a Revenue Integrity Program that will make a difference?

If you’re seeking help with your Revenue Integrity program, we have the upmost confidence in our abilities to assist you. Our team consists of industry leaders who, over the last decade, have worked together inside healthcare systems and/or in a consulting capacity. These long-standing working relationships and deep understanding of strengths and style has enabled us to place the right leaders at the right organization at the right time. At the end of the day, we want to do what’s right for our clients while providing a unique perspective and creative approaches in helping to solve their revenue integrity challenges.

The post What is Revenue Integrity Anyway? appeared first on RoundTable Strategic Solutions.

TALENT. RoundTable’s interim leaders (industry top talent) have lived inside the four walls of a healthcare system for the majority of their careers, leading successful and high performing teams and functions (both Hospital & Ambulatory), and now leverage their strong background and experience to assist organizations in filling Interim Revenue Cycle Leadership roles while also improving performance, centralizing / standardizing key functions, developing programs and identifying hidden undervalued talent from within the organization.

VOI. Our talented team of interim leaders continuously deliver intangible value for our clients.  They understand the importance of gaining trust and developing credibility with employees in the early phases of their interim engagements through good communication and by working with the front-lines up to the highest level of Managers and Directors to truly understand individual goals, challenges and road blocks as it relates to doing their job effectively.  Throughout this organic process, our team is able to identify and evaluate potential internal leaders whom they can mentor and train over time to help drive a performance-driven culture and potentially replace them as a FT leader.

ROI. Identifying lost revenue opportunities and driving the execution of realizing those dollars is key.  Our team enters each engagement with a focus to improve financial performance while understanding that implementing the operational and cultural performance improvement initiatives is a critical driver to realize financial success.  Over the last year, our team has not only identified internal talent and improved the operational efficiency of key functions, we have also produced real ROI dollars for our customers.  For a large academic medical center in the Northeast, we developed a Revenue Integrity program that identified and realized over $1 Million of otherwise lost revenue.  At another engagement in the Midwest, our team was able to improve the Clean Claim Rate by 30%, resulting in a $2 Million financial improvement — all in just two weeks. These examples are just a small sample of the valuable, but significant work efforts that our Interim Leaders continuously deliver for our customers.

We have the upmost confidence in our Interim Leaders and truly believe that we have the industry’s best talent.  Most of our team consists of industry leaders who, over the last decade, have worked together inside healthcare systems and/or in a consulting capacity.  These long-standing working relationships and deep understanding of strengths and style has enabled us to place the right leaders at the right organization at the right time.  At the end of the day, we want to do what’s right for our clients while providing a unique perspective and creative approaches in helping to solve performance and talent management challenges.

 About the author: Art Lopez is a Senior Executive at RoundTable Strategic Solutions overseeing growth, marketing and client engagements in the Eastern U.S. Region.  Art has spent a large portion of his career focused on leading the early stages of operational and commercial development, go-to-market strategy and overall growth for young and innovative companies at the forefront of the healthcare industry. His 12+ years of healthcare and leadership experience and working closely with the key segments of the market has allowed him to bring his clients a unique and holistic perspective as well as creative approaches in accomplishing organizational goals.

 RoundTable is a boutique Healthcare Management and IT consulting firm that consists of progressive industry veterans. With offices in Baltimore, Charlotte & Boston, RoundTable specializes in assisting health systems nationwide with their overall growth strategy and execution – patient acquisition and retention, revenue cycle performance improvement – both operational and financial, talent management, and Interim leadership. 

 For more info on our team, services, approach and experience, please click here.

The post Revenue Cycle: Addressing the Talent Gap While Improving Performance appeared first on RoundTable Strategic Solutions.

The What:  What do they need to know? 

Coders’ expanded knowledge is now required to fully understand their role within the revenue cycle.  Their job can no longer be that of just silent coding for hours, day in and day out. Rather, there needs to be an educational component of how they fit into the revenue cycle and how their role, which is sometimes overlooked, is an integral part of optimizing reimbursement while ensuring compliance with state, federal and payor coding guidelines.

They need to know the downstream and upstream effects of revenue cycle performance and the journey of the claim. The Charge Description Master (CDM) and Fee Schedules are the back-bone of revenue cycle processes and their maintenance and accuracy can impact the bottom line – positively and negatively. While Computer Assisted Coding (CAC) and “claim scrubbers” tools have been implemented at health systems and physician groups to assist in solving for the shortage of Certified Professional Coders (CPC) within our industry, the reality is coders will continue to play a pivotal role for the foreseeable future. Focus on continued education, cross-training and retention programs.

In either instance, accurate and compliant coding practices drive financial performance by mitigating compliance risk along the way. The government and commercial payers are scrutinizing provider documentation to reduce unnecessary procedures that increase cost of care while ensuring the quality of care continues to rise.  Never before has the process of medical coding been so relevant to the performance of the revenue cycle.

The How:  What do coders need to do?

1. Better understand the Life of a Charge within your health system. You don’t know what you don’t know! The puzzle requires your input.
2. Understand how charges are priced and fee schedules are negotiated: they are defensible (how and why it is priced that way); they are consistent (support the charge); and they are documented (show outside constituents how it was priced).
3. Continue to educate themselves and expand their knowledge about their organization’s revenue cycle – learning what and why things happen and ways to improve the process.
4. Create a Revenue Integrity Program to help reduce denials, drive financial performance and minimize compliance risk. When done properly this program can fund itself… and then some!
5. Become involved in continuing education programs. Attend seminars and conferences to learn about the trends of the coding profession.

The ultimate takeaway: Coders need to play a larger role in solving the revenue cycle puzzle. They need to become engrossed in the revenue cycle and truly understand the ins and outs of the process, while fully recognizing that, much like a puzzle piece, they each belong to something much greater than themselves.

The post Coders: A Major Puzzle Piece in The Revenue Cycle appeared first on RoundTable Strategic Solutions.

Alignment between health system CFOs, Revenue Cycle, Physician, Compliance and Operational leadership is critical to successfully launch or enhance a Revenue Integrity strategy and program.  Leveraging outside experts who have designed, implemented and built Revenue Integrity programs inside complex delivery systems can balance the organizational drive to increase revenue with the imperative to comply with legal and contractual rules.

Partnerships with health system leadership can assist in creating a strategy, defining an achievable plan to optimize your existing Revenue Integrity program or implement a program that mitigates risk to revenue – ensuring compliance, leveraging existing coding/charge capture tools and technology, and creating a sustainable model to embrace both fee for service and value-based care reimbursement models.

Below are 7 Key Steps to Consider When Building Your Revenue Integrity Program

1. Obtain buy-in with Executive Leadership, Compliance, IT, CMIO, Clinical Operations
2. Leverage data and analytics to identify Areas of Opportunity, ROI & Accountability
3. Identify Revenue Integrity Team Leader (+Manager, Staff & Physician Advocate) and Identify key roles, responsibilities and job descriptions
4. Align to Other Revenue Cycle Performance Improvement Projects
   • Revenue Cycle Liaison Program to Clinical Departments
   • Clinical Documentation Improvement and System Upgrades
   • Denials Management
5. Define Revenue Integrity structure, stakeholders and governance
6. Select tools to monitor performance (staff & financial gains)
7. Finalize annual Revenue Integrity Work-Plan

Need assistance in building or enhancing your Revenue Integrity program? We welcome you to contact us today to learn more about our Revenue Cycle strategies, Interim Leadership and our proven successful results by emailing our team at oursolutions@roundtablehit.com.

*Becker’s Hospital Review, October 4, 2017

The post Building Blocks to a Successful Revenue Integrity Program appeared first on RoundTable Strategic Solutions.

As we attended multiple sessions and walked the show floor, we saw several trends and had six major takeaways:

1- Interoperability

• The industry is experiencing interoperability issues which have spawned a whole host of middleware and interoperability vendors and consultants.
• The true solution relies upon creating and enforcing healthcare standards within the software frameworks themselves instead of allowing health records companies to continue to develop proprietary software.

2- Technology, Data and Analytics…and what to do with it?

• In the early days of the internet, websites had the same challenges we see in many of the healthcare software products today: They are created under the belief that more is better, which creates an overwhelmed end user.
• These overly complicated products tend to be a result of the lack of clarity on how to use the technology and the data needed to provide useful analytics and visualizations.
• The end result: Too many functions that do nothing, too many screens that are under utilized and too many graphs and charts that provide little to no meaningful or actionable intelligence.
• The solution: Look past the clutter, focus on understanding the user/business/clinical/operational problems, and define a strategy on how to utilize the data and analytics.

3- Care Management/Pop Health and CRMs

• It’s my opinion there will be a collision of these two products in the near future.
• The reality is that these spaces overlap and the appropriate data served within a care management tool is useful within a CRM. More so, the data within a CRM is necessary within a Care Management tool if the care manager is to successfully contact patients (i.e. best method of contact, etc.)
• It’s extremely valuable for this intel to be incorporated in the Care Management tools in order to contact patients for the right reason at the right time.

4- Mobile Solutions

• In an attempt to treat patients as consumers, there are many vendors offering mobile solutions.
• Apps, portals…. Nothing really revolutionary, however, it shows that the industry is headed in that direction.
• More people search from their phone, rather than from their laptop; and now is the time to incorporate that consumer need into the healthcare industry.
• The right app development is critical to engaging with consumers.

 5- Patient Financial Responsibility – The Revenue Cycle Experience

• Due to HDHP’s and technology, patients are becoming more knowledgeable consumers who demand better communication, cost transparency, easy and convenient payment methods and plans, and easy & convenient scheduling/registration options.
• Health systems are addressing these demands through revenue cycle operational/workflow redesign, improved customer service and partnering with vendors that provide services and technology to improve the overall patient experience as it relates to billing/payments.

6- The self-fulfilling prophecy that healthcare is too complex

• Buyers realize that there are so many “solutions” and that some of them don’t solve their actual problems.
• The majority of products have become cumbersome with too many clicks, too many screens – leading to long educational hours of determining the right screens and data needed.  And like all technology, by the time they get something they can use, a new update appears and changes it all.
• Healthcare can be a difficult and complex industry. We all know that the software systems are lagging behind other industries; however, as experts, we need to realize that it’s a challenge we can overcome.  It’s time to take the leap and treat patients as consumers; and develop software systems that meet those demands.

We welcome you to contact us today to learn more about our Healthcare Consumer Experience & Relationship Management (HCxRM) and Revenue Growth & Integrity strategies as well as our team that can guide you in the right direction by emailing us at oursolutions@roundtablehit.com.

Experiences shared by Mike Schwob, Director of Management Consulting.

The post Never Stop Learning and Leading – HIMSS18 Takeaways appeared first on RoundTable Strategic Solutions.

In recent months, CFOs, Vice Presidents of Revenue Cycle, and Executive Directors have engaged RoundTable Strategic Solutions to develop a go-forward strategy to improve the financial viability and stability of their organization while identifying opportunities to enhance/optimize patient access and the overall consumer experience. Our proven approach provides clients with solutions that leverage operational re-design, reduce manual processes using information technology and create a sustainable model for growth within today’s healthcare delivery and rapidly changing reimbursement model.

RoundTable’s Management and Revenue Cycle Consulting teams are guiding many large and complex healthcare delivery systems in the following areas:

• DRIVING A NEW CULTURE OF PERFORMANCE & GROWTH: Providing Interim Revenue Cycle Leadership at a leading Academic Medical Center in the Northeast with responsibilities overseeing the day-to-day oversight of physician and hospital operations while serving as the “agent for change and innovation.”

Inattention to revenue cycle process, workflows and IT solutions can impact hospitals and physician groups upwards of $10M plus annually.

• DEVELOPING A NEW OPERATING STRUCTURE: Conducting a comprehensive revenue cycle assessment, reviewing staffing, size, structure, processes, and re-designing P&P’s for a Multi-State Integrated Delivery Network with 300 employed and community providers.

Implemented Denial Management Program and Policies & Procedures to reduce $8M in denials and assisted with the identification of two new outsourced RCM vendors.

• MAXIMIZING REIMBURSEMENT FOR ALL MODELS: Designing and implementing enterprise-wide Revenue Integrity programs to improve charge capture, CDM maintenance, physician documentation and compliance for a leading Academic Medical Center and Integrated Delivery Network.

Research states that 69% of organizations that implemented a new revenue integrity department increased net collections and gross revenue capture.

• OPTIMIZING ACCESS AND “KEEPAGE”: Overseeing the design and centralization of key revenue cycle and patient access functions including: registration, scheduling, eligibility verification and pre-authorizations for a 10-hospital IDN with 2,000 physicians in the Southeast.

Efforts resulted in a 12% increase in patient access and 36% decrease in registration related denials.

• LEVERAGING TECHNOLOGY TO IMPROVE PERFORMANCE: Advising Revenue Cycle and IT leadership on the advanced features and functionality available within their Practice Management and EMR solutions that drives automation, improves revenue cycle performance and clinical documentation.

79% of healthcare revenue cycle management priorities are enabled by health IT solutions and optimization.

We would welcome the opportunity to share more about our relevant background, experience and engagements while learning more about your current organizational needs and challenges.

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