Match your Revenue Cycle Management Vendors to your Goals, not theirs

Now that we’ve ushered in 2022 with shiny new goals and KPIs, what will we do to ensure that we meet or exceed these ambitious goals? How can we arm our clients with the right services to match their most pressing needs and improve their net financial performance? 

Invicta Health Solutions has a not so secret weapon in the form of Revenue Integrity Director Michael “Mike” Wilson. Mike brings the experience and voice of a veteran healthcare PFS Director and provider to the table. He has a thorough understanding of all aspects of the revenue cycle journey and deploys his broad healthcare industry knowledge to support Invicta’s client and Company goals in revenue performance; financial analysis; reporting and compliance; and operational data analysis for client decision-making. This month, we asked Mike to do what he does best: Put himself in the virtual seat of healthcare administrators and CFOs around the Country and tell us all his problems. 

What are the priority goals for healthcare administrators and CFO’s when it comes to revenue cycle performance?
 


This very question is the best pause point for a real and transparent discussion on client priorities. Every hospital system and every facility are completely unique. Sure, there are some common concerns on everyone’s mind today. You can read numerous articles and surveys on what’s HOT, and I’ve heard a variety of goals – along with the associated concerns – from my conversations with peers.

General top of mind common goals, in no particular order, for the year likely include:

  • Creating better net reductions in overall costs of collection
  •  Increasing net patient revenue opportunities
  •  Moving more of the payor mix from charity care to government-based reimbursement
  •  Lowering outstanding days in accounts receivable
  •  Increasing patient engagement by moving uninsured to insured
  •  Countering staffing pressures for facilities in small towns and rural markets – or really all markets, given the Great Resignation
  •  Prioritizing pain points and developing a logical path to address them
  •  Creating ways to reduce budgetary pressures

That said, it is far better to drill down to the respective client’s priority list. One of the biggest differentiators for Invicta is our ability to shift to best align with the client’s needs, rather than our desire to provide just one service line. We customize our strengths to match your needs, eliminating the need for a one size fits all approach.

What are the services and solutions that can be most easily out-sourced to relieve pressure on the internal hospital team?


I believe the best “bang for the buck” for hospital revenue cycle improvements this year will come through breakthrough solutions like Insurance Discovery, Real Time Eligibility and Real Time Claim Status. Finding more payment sources and finding them faster creates a positive experience for patients while also improving cash collected and account receivables that would otherwise be reserved as bad debt. Since we can complete eligibility checks for more than 1,000 payers nationwide and claim status for 700+ payers nationwide with a simple one-page signed form, any system or facility of any size in any market can benefit. 

Next on the list is Denial Management, primarily because the denials process is typically fraught with both coding, human and payor error. Every payment, even low dollar, should receive reimbursement. Advanced technology and expert staff can deliver better results for denials with all payers and all balances. We can quickly conduct a root cause analysis making it easier to mitigate risks of future denials and get paid faster. 

I also would include Out of State Medicaid Billing on this list. Many hospitals needlessly ignore this potential revenue stream and just automatically classify these patient charges as charity care versus implementing an appropriate and cost effective Out of State billing program especially since many States have expanded their Medicaid coverage. Every state has a unique Medicaid process. Sometimes, the biggest hurdle is in simply registering with the state. It’s difficult to maintain an in-house team that is up to speed on the latest state policies. With Out of State Medicaid, our RCM team continuously familiarizes itself with changes on a state-by-state basis. If you have no program now, you have nothing to lose except a lower margin. 

What is the most underrated value in revenue cycle vendor effectiveness?

It’s been my experience that relationship management is the key to success for hospitals and their vendors. How do we measure and quantify trust and effective communication? Regardless of what services and/or solutions an entity outsources to a vendor, the metrics in evaluating the value of the vendor don’t always include – and should – ease of use and collaborative communication. Truthfully, no administrator wants to change vendors. Ever. It’s complicated, time consuming and not free of risk. Change can be difficult. 

When we look at a vendor relationship, we make decisions based on quality and/or pricing. But if the relationship is a strong one, we will undoubtedly see results in the quality of the work as well as the bottom line. Constant, open, and direct lines of communication between a service provider and client paves the way for effective project management, quality control, and mutual trust.  

Final thoughts?

There has never been a more exciting or challenging time to work in healthcare revenue cycle management. As organizations make strides toward their determined goals for 2022, we must take with us the lessons of 2020 and 2021: Be nimble, tech-forward, disciplined, and – most of all – never forget that our successes impact more than our bottom line. They make a difference in the lives of real people. 

If you’d like to bring Invicta’s services and solutions to your organization, contact us at info@invictahs.com for more information. 

LEARN MORE


Now that we’ve ushered in 2022 with shiny new goals and KPIs, what will we do to ensure that we meet or exceed these ambitious goals? How can we arm our clients with the right services to match their most pressing needs and improve their net financial performance?

Invicta Health Solutions has a not so secret weapon in the form of Revenue Integrity Director Michael “Mike” Wilson. Mike brings the experience and voice of a veteran healthcare PFS Director and provider to the table. He has a thorough understanding of all aspects of the revenue cycle journey and deploys his broad healthcare industry knowledge to support Invicta’s client and Company goals in revenue performance; financial analysis; reporting and compliance; and operational data analysis for client decision-making. This month, we asked Mike to do what he does best: Put himself in the virtual seat of healthcare administrators and CFOs around the Country and tell us all his problems.

What are the priority goals for healthcare administrators and CFO’s when it comes to revenue cycle performance? 


This very question is the best pause point for a real and transparent discussion on client priorities. Every hospital system and every facility are completely unique. Sure, there are some common concerns on everyone’s mind today. You can read numerous articles and surveys on what’s HOT, and I’ve heard a variety of goals – along with the associated concerns – from my conversations with peers. 

General top of mind common goals, in no particular order, for the year likely include:

  • Creating better net reductions in overall costs of collection
  •  Increasing net patient revenue opportunities
  •  Moving more of the payor mix from charity care to government-based reimbursement
  •  Lowering outstanding days in accounts receivable
  •  Increasing patient engagement by moving uninsured to insured
  •  Countering staffing pressures for facilities in small towns and rural markets – or really all markets, given the Great Resignation
  •  Prioritizing pain points and developing a logical path to address them
  •  Creating ways to reduce budgetary pressures

That said, it is far better to drill down to the respective client’s priority list. One of the biggest differentiators for Invicta is our ability to shift to best align with the client’s needs, rather than our desire to provide just one service line. We customize our strengths to match your needs, eliminating the need for a one size fits all approach.

How can RCM service providers weaponize their services to help clients manage the financial losses associated with the Great Resignation?

Personnel and staffing turnover are both a stressor and a revenue hit for employers. As Donny indicated in his 2021 Year in Review address, the Healthcare industry is facing an industry-wide shortage of trained staff, which has made it difficult for hospitals to achieve their financial performance. Invicta has a distinct advantage because our infrastructure has been built on secure, cloud-based products and services. Anything that can be done in an off-site, remote manner to deliver performance has been developed. 

The more that we can help stabilize the systems and remove impediments to the client’s staff roles that require talent, the better ROI for the internal RCM team. We’re not replacing humans with machines: We’re addressing the most repetitive tasks with artificial intelligence like RPA so that human intelligence can drive innovation, interpret nuances, and create intervention. As someone who has spent 30 years in this business and has seen the results we can generate here at Invicta with purely remote people, process, and tech, I’m a believer.

What are the services and solutions that can be most easily out-sourced to relieve pressure on the internal hospital team?

I believe the best “bang for the buck” for hospital revenue cycle improvements this year will come through breakthrough solutions like Insurance Discovery, Real Time Eligibility and Real Time Claim Status. Finding more payment sources and finding them faster creates a positive experience for patients while also improving cash collected and account receivables that would otherwise be reserved as bad debt. Since we can complete eligibility checks for more than 1,000 payers nationwide and claim status for 700+ payers nationwide with a simple one-page signed form, any system or facility of any size in any market can benefit. 

Next on the list is Denial Management, primarily because the denials process is typically fraught with both coding, human and payor error. Every payment, even low dollar, should receive reimbursement. Advanced technology and expert staff can deliver better results for denials with all payers and all balances. We can quickly conduct a root cause analysis making it easier to mitigate risks of future denials and get paid faster. 

I also would include Out of State Medicaid Billing on this list. Many hospitals needlessly ignore this potential revenue stream and just automatically classify these patient charges as charity care versus implementing an appropriate and cost effective Out of State billing program especially since many States have expanded their Medicaid coverage. Every state has a unique Medicaid process. Sometimes, the biggest hurdle is in simply registering with the state. It’s difficult to maintain an in-house team that is up to speed on the latest state policies. With Out of State Medicaid, our RCM team continuously familiarizes itself with changes on a state-by-state basis. If you have no program now, you have nothing to lose except a lower margin.

 

What is the most underrated value in revenue cycle vendor effectiveness?


It’s been my experience that relationship management is the key to success for hospitals and their vendors. How do we measure and quantify trust and effective communication? Regardless of what services and/or solutions an entity outsources to a vendor, the metrics in evaluating the value of the vendor don’t always include – and should – ease of use and collaborative communication. Truthfully, no administrator wants to change vendors. Ever. It’s complicated, time consuming and not free of risk. Change can be difficult. 

When we look at a vendor relationship, we make decisions based on quality and/or pricing. But if the relationship is a strong one, we will undoubtedly see results in the quality of the work as well as the bottom line. Constant, open, and direct lines of communication between a service provider and client paves the way for effective project management, quality control, and mutual trust. 

Final thoughts?

There has never been a more exciting or challenging time to work in healthcare revenue cycle management. As organizations make strides toward their determined goals for 2022, we must take with us the lessons of 2020 and 2021: Be nimble, tech-forward, disciplined, and – most of all – never forget that our successes impact more than our bottom line. They make a difference in the lives of real people. 

If you’d like to bring Invicta’s services and solutions to your organization, contact us at info@invictahs.com for more information. 

LEARN MORE