All posts by Nearterm Houston

5 Big Hospital CFO Concerns for 2015

5 Big Hospital CFO Concerns for 2015Are These Still the 5 Big Hospital CFO Concerns for 2015?

According to an article by Rene Letourneau, for HealthLeaders Media, December 1, 2014, where he interviewed a number of CFOs, there are 5 Big Hospital CFO Concerns for 2015. Now almost in the middle of 2015, do you agree with his prognostications?

  1. Declining Utilization

As hospitals move towards a value-based system, the quality of care improves and so too, do patient outcomes. With that success comes reduced patient volume (and revenue) as inpatient care declines. All that can have a negative impact on the hospital revenue cycle.

Medicaid expansion offers only short term help as more patients coming from the previously uninsured low-income population. “Bigger forces will continue to drive down utilization.”

Better ways of delivering care must be found that do not impact the revenue stream or the quality of care in a negative way. Balance has to be found.

  1. High Deductible Health Plans

As patients are now faced with higher deductibles, it is expected that collections in 2015 will increase unless CFOs “rethink internal processes in order to protect revenue.”

Through outreach and early and frequent patient engagement, CFOs are considering moving the revenue cycle process upfront to forestall collection issues at the back end. Solutions considered include educating patients about their financial obligation early and offering options to facilitate payment either through upfront payment or financial assistance.

  1. Downgraded Credit Ratings

“As we move away from fee-for-service reimbursements, the investments we have to make are not capital investments. They are operating investments that cannot be capitalized or amortized.”

Equipment and facilities can be capitalized but “integrating our physicians and becoming a clinically integrated network” cannot be capitalized.

  1. Medicaid Expansion Woes

“Many health systems in states that are not expanding Medicaid are facing real financial peril due to significant cuts to the Disproportionate Share Hospital program, which makes federal payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals.”

Even for hospitals in states that have expanded Medicaid there is risk. “As we all know, when the economy takes a downturn, one of the first places states look to cut is Medicaid so having more Medicaid beneficiaries means having more risk.”

  1. Making EHRs Pay Off with Actionable Action

“Once an EHR is up and running, the key to maximizing it from the financial perspective is to extract and analyze the data in a way that leads to standardization of care and a reduction in the use and duplication of expensive clinical resources.”

Read the entire article written by Rene Letourneau, for HealthLeaders Media , December 1, 2014.

Posted By: Nearterm Houston

Creating a Hospital Quality Management Cycle

According to Susan DeVore, president and CEO of Premier, Inc., a healthcare improvement company, today’s healthcare providers are being judged on more than the amount of payment for a procedure and the effectiveness of their billing and collection process. They’re also being increasingly evaluated based on their quality, creating a need for “total quality management.”

 

Building a Quality Management Cycle in Healthcare Operations

 

quality management cycle in healthcareIn a new op-ed published in the Wall Street Journal, Devore notes that, in today’s health-care industry, “the quality of care is just as important to a hospital’s revenue as making sure claims are paid properly.” Additionally, federal programs requiring hospitals to publicly report their outcomes, as well as rewards or penalties as a result of these outcomes, put pressure on hospitals to perform well. As a result, understanding how to measure performance is essential to a hospital’s success.

 

“Much like the revenue cycle process, hospitals need to be able to keep track of and manage the quality cycle of care to determine the most important areas of focus and consistently meet high-performance measures,” she writes. “If we take some of the best practices from the revenue cycle, we can implement a quality cycle management process that aligns and focuses firmly on the specific elements of performance that produce continuous quality improvement, and in turn, a healthier balance sheet.”

 

In the article, Devore notes that these “best practices” include “a clear cadence, metrics with targets, a firm culture of accountability and… deep executive engagement to generate change.”

 

“Yesterday’s revenue cycle management is today’s quality cycle management,” she says.

 

Nearterm sees quality metrics of revenue cycle management for hospitals as a subset of the overall mission that hospitals embrace which is to deliver quality care in a sustainable way. Quality cycle, in our opinion, is as much among the objectives of RCM as it is also among the objectives of Nursing Services, Supply, and other operational areas of care.
Posted By: Nearterm Houston

AMA President Urges Physicians to Prepare Billing Cycles for ICD-10 Implementation

In response to a letter to the Centers for Medicare & Medicaid Services (CMS), which expressed concern regarding the potential for an accumulation of millions of dollars in unpaid Medicare claims following the ICD-10 implementation, American Medical Association (AMA) President Robert M. Wah is urging physicians to prepare their billing cycles for the transition.
The letter, which was a joint effort from a hundred physician groups, including the AMA, expressed concern that contingency plans have not been established to prevent critical billing disruptions caused by the implementation of ICD-10, which goes in to effect October 1.
“By CMS’ own analysis, one of the most significant risks to moving to ICD-10 is the likelihood for claims processing and cash flow interruptions,” the letter states.
AMA President Wah told RevCycleIntelligence.com that the biggest concern regarding the transition to ICD-10 was demonstrated in CMS’s end-to-end testing, which found a decline in claims acceptance, from 97 percent to 81 percent, among the relatively small sample size tested.
“When this is expanded to all physicians and all claims, the results may be disastrous,” Wah said.
Wah also pointed to issues with previous HIPPA implementations, including NPI and Version 5010, which left some physicians unable to be paid by Medicare for several months.
“Some practices were at the point of being unable to make payroll for staff and needing to temporarily close the practice, or obtain lines of credit with financial institutions until processing was complete,” Wah states. “We are extremely concerned that physicians will face similar issues as a result of the switchover to ICD-10.”
To prepare for the transition, Wah is urging physicians to prepare for the federal mandate.
“Physicians will need to closely track various metrics for their claims including pending claims, rejected claims, days in accounts receivable and payments,” says Wah. “Any issues will need to be addressed and reworked as early as possible to prevent a backlog of unprocessed claims and lack of reimbursement.”
Nearterm can help you get your RCM in top shape in preparation for the ICD-10 compliance date of October 1. We offer coders, claims specialists, and billers to work onsite or remotely. 
 
Read the entire article on RevCycleIntelligence.com
Posted By: Nearterm Houston

How Outsourcing RCM Supports Company Growth: A Client’s Perspective

Several years ago, Capital Women’s Care (CWC), an obstetrics and gynecology group in the Maryland, Virginia and Washington, D.C. areas, was facing a challenge with regards to their revenue cycle. According to Debbie Redd, CWC’s President and CEO, the practice’s revenue cycle was “not functioning to its full potential,” hindering the company’s ability to grow.
In a recently-published article from Healthcare Finance News, Redd details how the practice overhauled their revenue cycle management system by streamlining the internal front-end financial processes and outsourcing back-end billing efforts.
According to Redd, the choice to outsource was a “practical alternative to keeping things in-house,” as it allowed the practice to “rely on an expert whose sole business is revenue cycle management” while freeing up time for the practice to “focus on expanding… and supporting providers in high-quality clinical care for patients.”
Overall, Redd concludes that outsourcing back-end processes both stabilized CWC’s financial operations and built a foundation of support for the company’s expansion. 
 
“Before we began outsourcing our backend processes, our days in A/R were over 100,” writes Redd. “Now we consistently see rates of less than 20. We also have about a 99 percent collection rate.”
 
Additionally, Redd notes that the strong changes made to the front- and back-end of the revenue cycle make the organization “more attractive to new providers and potential partners.”
“Providers come to us seeking membership because they see how we effectively manage both the clinical and business sides of the practice. This has allowed us to expand our business and prepare for the coming changes in healthcare.”

Read the entire article on Healthcare Finance News.

Nearterm provides healthcare revenue cycle management consulting (RCM) services for hospitals, medical clinics, and physician practices. Our RCM services are designed to provide clients with practical solutions and assist them toward strengthened financial positions.

 

Posted By: Nearterm Houston