Category Archives: News

Hospitals Staffing Levels Improve With RCM Solutions

rcm solutions

There’s no doubt that healthcare workers are the backbone of the health service, so it makes sense for a healthcare provider to manage their staffing levels in a strategic manner. Revenue cycle management (RCM) services help hospitals to meet staffing needs while saving money. This cost-effective approach is gaining momentum as healthcare providers strive to offer excellent care while meeting business needs.

The Market Is Changing

Nowadays healthcare workers enjoy the freedom of being able to work flexibly and at different locations, because they don’t like the idea of being tied down to one place. Also, they like to make the most of the opportunities that arise at any given time, because they understand that this will add to their employment portfolio. This model is also beneficial for healthcare providers, as it makes the process of hiring skilled staff easier, and because contract workers often get paid a little more than in-house staff, they don’t have to offer benefit packages.

According to Global Human Capital Trends 2015 series, more than one-third of all workers in the United States are contract workers. What’s more, just over half of all respondents say that their need for contingent workers will continue to grow over the next three to five years as the market shifts toward a more agile workforce.

Contract Workers on Demand

Many firms rely on contract staff to meet supply and demand, but with hospitals, the need for contingent workers is even greater, because they simply can’t afford to be understaffed. Healthcare providers constantly need to meet their patients’ needs so that they can provide a good level of care.

rcm solutions

Nearterm’s 360 Managed Services can help you meet your staffing needs by meeting with you to discuss your requirements. Project staffing involves meeting with one of our experts to ascertain the type of workers you are looking for. This will include skill set, the scope of work, project details, schedule and other related matters. Once this has been established, we gather the resources you need and arrange for them to be there as and when you need them, both on-site and remote.

Revenue Cycle Management Service

RCM services manage a number of business-related tasks so that you can get on with what you do best: caring for your patients. These RCM services include:

  • Situation Analysis — Objective operations assessment to facilitate planning and decision-making processes.
  • Operations Action Plans — The plan of action process is a proprietary service wherein Nearterm leads your organization through a very structured process aimed at establishing targeted change.
  • Implementation Assistance — We deliver the additional ”horsepower” you need when implementing certain planned activities.
  • Organization Development — Our team of professionals serves as the catalyst your organization needs in the development process.
  • Centralization and Decentralization — We specialize in assisting providers with all aspects of centralization and decentralization, from the earliest consideration through the continuum.

In addition to RCM services, we also:

  • Present customized training programs
  • Develop and document policies and procedures
  • Provide conversion assistance
  • Design reporting packages
  • Tailor our services to meet your organization’s specific needs

RCM services help you to plan better so you can deliver top-quality care in this increasingly competitive market.  Hospital finance departments are often under pressure to crunch the numbers and balance the books. But without careful planning, recruiting staff can be more expensive than it should be. If you want to find out more about what we can do for your organization, please get in touch.

Posted By: nearterm-admin

Should Hospitals Leverage Outsourced Coding or Keep It Internal?

Hospitals have adapted many different coding models. Most are designed around contributing factors that differ from one facility to the next. However, there are three models that arguably prevail. The following is a summary of each;

MODEL I-INTERNAL

All coding functions are managed and performed by internal staff/employees. The function is generally housed at the facility. Some remote coders may be used but they are hospital employees. Hospital is responsible for audit, QA, productivity, staff management, technology, employer taxes and employee benefits.

MODEL II-HYBRID

Coding is managed internally. Most coding is done internally by hospital employees but some coding is outsourced to a vendor. Hospital manages both employees and the vendor.

MODEL III-OUTSOURCED

The coding function is outsourced to a vendor.

Each of the above can be successful. That said, many hospitals are rethinking and reinventing their processing environment. The driver is often an awareness of current state and how it has changed. Here are some examples of current state “influencers” gleaned from discussions with several hospitals and HIM professionals;

“ICD 10 coding implementation has resulted in staff increases. I have space constraints so I have no work area to accommodate additional staff. Besides, our leadership team believes the space currently occupied by HIM could be put to use for revenue generating services.”

“We are in a rural community and local coders are hard to find and retain. Turnover and leaves of absence require overtime. We usually get behind when these occur and morale is impacted. When new services are introduced, we are challenged to find coders qualified to code the new services. Billing gets behind, cash flow suffers and physicians are irritated by late query requests.”

“A recent coding audit revealed that coding accuracy among our coders ranged from 79% to 91%. This was a surprise since we had not had an audit done all year. Review of the audit results by coder made it clear that we had both performance issues and training deficits. The CFO had approached us about why the denial rate increased in recent months – now we know.”

“The DNFB standard at our hospital is no more than 3 days revenue. We meet that standard occasionally but typically run at about 7 days. Week-ends, holidays, technical issues, turnover and absences are keeping us from meeting our standard. Overtime is not approved here so performance suffers.”

Coding outsource is not for every facility but it is an option that meets the influencers illustrated above head on. The benefits of outsourcing include:

  • The facility no longer incurs certain costs shifted to the vendor:
    • Employer FICA taxes
    • Workers comp, health benefits, retirement plan
    • PTO & holiday pay
    • Software licensing and maintenance
  • Space occupied by internal coding staff can be used for revenue producing or other services deemed strategic:
    • Desks, office equipment, phones etc. can be re-purposed
  • Staffing problems are eliminated. The outsource vendor maintains expert staff with credentials and experience to accommodate any service type while meeting production standards. Coverage for vacancies, holidays, week-ends and PTO is provided by the vendor.
  • Testing, training, continuing education, meeting attendance, trade association dues, audits and other “soft cost” items are the responsibility of the vendor.

It is important to consider not only influencers but also “inhibitors” related to outsourcing when assessing the processing environment for your coding function. Inhibitors might include the absence of technology to support remote processing, the perception of job loss or merger/acquisition activity that prohibits contracting. Another inhibitor is the unwillingness to partner – the outsource option requires good communication and a “partnering approach” in order to capture the many benefits associated with it.

This article is only a summary of different medical coding options. We hope you find it thought provoking. Whether you are considering outsourcing the entire coding function or you simply need coding support from time to time, or maybe Interim HIM Leadership, we at Nearterm are available to assist you.

Feel free to call or ask the experts if you would like to access our team or offer comments about this topic.

Posted By: nearterm-admin

Hospital Classification: A New Normal For Financial, IT and RCM Professionals

RCM Consultants

Hospitals have been and still are classified in various ways, depending on the purpose of the hospital classification and how it is to be used. Examples include ownership, bed capacity, service capacity, specialty, teaching, acute care, critical access, location, research and there are many others.

A “new normal” classification methodology has emerged and it is referenced early in most any dialogue with Financial and RCM Professionals that references what is going on in their hospital. It is a kind of subset of the conventional classifications referenced above. It addresses where the hospital is in terms of IT Systems. The three descriptors are illustrated below and it seems that today, every hospital is in one of these stages.

DECISION

  • What is driving the consideration?
  • Which product is best for my facility?
  • Financial impact and budget prioritization?
  • Move forward now or delay the decision?
  • What modules do we need?
  • Vendor selection process?
  • Enterprise integration?

IMPLEMENTATION

  • How do we handle legacy AR?
  • Existing team migrate to training while we bring in external resources to run the shop or the inverse of that?
  • If we deviate from the conversion implementation plan or get behind as “go live” approaches, how do we get back on track?

REMEDIATION

  • Does it make sense to conduct an objective post-conversion discover process?
  • How do we recover from the aftermath of the conversion (backlogs, unanticipated conditions etc.)?
  • Do we need to consider “bolt-ons” to accommodate processes that are not well managed by the new system?

Regardless of where your hospital is in this continuum, the body of associated work represents increased demand for resources and expertise. After all, prior to landing in one of the categorizations above, the hospital team was fully engaged managing day-to-day operations. The content summarized above under each categorization must be addressed in addition to managing the routine functions that are required of the revenue cycle, IT and finance team(s).

Most hospitals recognize the increased demand and engage external healthcare management resources to assist them, especially during IMPLEMENTATION as described above. The decision regarding how to use those external resources can depend on the strength of internal resources, desired timeline, budget, operating conditions and other considerations specific to each facility. We commonly see one of two models;

  • MODEL ONE – BACKFILL OPERATIONS
    External resources (e.g. Directors, Managers, Supervisors) serve in an interim capacity to fill leadership roles. Technicians (e.g. billing, customer service, collections) are also brought in. These “backfill” resources maintain operations while the permanent hospital team focuses on build, training, and development of user proficiency.
  • MODEL TWO – BACKFILL CONVERSION ACTIVITIES
    External resources (E.G. Consultants, SME’s, Vendor Resources} are engaged to manage conversion activities while existing Hospital personnel continue to lead and maintain operations.

There is often overlap as we look at these models. This overlap can expand and contract as activities progress. It may even change so that we see a blended model. This can occur as a result of turnover, strategic redirection, unsatisfactory performance, and/or cost. However, deviation from the plan may have unintended consequences and should be carefully vetted prior to implementation.

It boils down to the realization that successfully managing hospital RCM, Financial and IT operations requires a multi-disciplinary team of dedicated professionals at various levels even when no conversion is underway. Definitely a “full-time job” for all involved. When we introduce conversions into the mix, we see an incremental increase in resource demand and the need for different kinds of expertise or “another full-time job” in addition to managing the hospital.

As external resources, we at Nearterm assist hospitals in every phase of conversion, centralization, and management. We are passionate about sharing the reservoir of applied methodologies and talented resources we have accumulated over the recent 20 years. We are also passionate about learning and we welcome your perspectives so please feel free to comment on this blog or simply give us a call.

Posted By: nearterm-admin

Revenue Cycle Management In 1951: It Used to be a Lot Easier…Or Was It?

Revenue Cycle Management In 1951

The above image is an actual hospital bill and accompanying explanation of charges used in 1951. Just think of the things that we didn’t have to manage back then. A short list might include coding, claim edits, massive denials, contract payment compliance, Medicare/Medicaid (both started in 1965), managed care contracts, HIPPA regulations, “patient-friendly” billing initiatives, use of technology, and outsource considerations.

We now embrace in stride all of the complexities that have evolved since this bill was produced. In fact, increasing complexity is the “new normal” in our business. The explanation of charges that accompanied this bill was actually pretty transparent for the time and was largely designed to help patients understand the difference between hospital and hotel costs. It was easy to understand the bill and the explanation. However, the expressed complexities that have emerged today make itemized bills almost unintelligible and our explanations often lead to more skepticism than acceptance. It’s not easy anymore!

In our company and in your hospital, we are attuned to customer service management and its importance in the revenue cycle continuum. Among revenue cycle and financial professionals, part of our jobs back in 1951 and presently today has always included the mantra “cash is king.” But today, more than ever, patients are decision makers. I can remember a time early in my career when my boss imparted to me that our “internal client” or “customer” was the physician because it was the physician who drove patients and therefore revenue to our facility. Now we have several customers, which is yet another added complexity.

However, in the shadow of all the differences one can enumerate between 1951 and today, there is one glaring similarity. RCM success is still about blocking and tackling. It still means the presence of a compassionate patient access process that results in a positive patient experience, while simultaneously recording data that enables us to populate a clean claim and collect revenue. It still means timely, accurate revenue capture and billing. It still means effective follow-up on billed AR and prompt recognition of collectability. Like you, our consultants, interim leaders, and staff augmentation specialists at Nearterm realize the importance of keeping our eyes on the prize – CASH IS STILL KING.

Oh well, maybe things haven’t changed after all! 😊

Jim Matthews
Principal, Nearterm Corporation

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Posted By: nearterm-admin
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