Category Archives: News

“Will We Pay These Guys More Than We Collect?”

Nearterm has an Interim Management contract serving one of our more complex multi-facility clients as Interim Revenue Cycle Director. One issue identified during initial analysis was a 7 figure backlog consisting of delinquent accounts with a reasonable probability of collection if worked properly. In this case it was determined that a lot of on-site research would be required. That determination led our client to consider the option of bringing in Interim AR Specialists (Billing and Collection Experts) to work in the business office rather than outsourcing the AR to a remote collection service.
When the Revenue Cycle Team presented this option to the CEO in the form of a recommendation, the very astute and entrepreneurial CEO asked a question that I thought was so simple it was brilliant:
I am a student of simplicity, among other things. My background in management consulting, organization development and revenue cycle strategy has required me to help hospitals transform seemingly overwhelming challenges into bite-sized action plans that are in a word “simple” enough to be actionable. So, when a client recently asked this question of one of our senior professional staff, I thought it was worth presentation.
Obviously there are a lot of surrounding considerations that would be answered before a decision could be made but if you can get to “yes” on this one, it certainly means you have mitigated the risk!
In many situations, it is advantageous to outsource to a remote service provider. We often recommend it and frequently help with vendor selection. However, in cases where extraordinary repeated interaction with case management, clinical, health information management, financial, IT and/or other disciplines is necessary at the account level, many vendors lose interest or minimize work protocols. In those cases onsite AR Specialists are a great option.


If you have experience with decisions related to this topic that would be helpful to your colleagues, please share. Nearterm is a repository for revenue cycle case study and we would welcome your input.
Posted By: Nearterm Houston

Hospital Access Professionals Wear A Lot Of Hats–How About “Loan Officer”?


Most hospitals understand how important admitting and registration professionals are in terms of public image and customer service. They are often the first encounter a patient has with a hospital and therefore represent the first opportunity for a patient and/or loved one to form an opinion about the facility. The intake process and even communication prior to arrival can make patients feel comfortable, confident and trusting in what can otherwise be a very intimidating provider system. That is important in today’s competitive healthcare environment where increasingly patients make choices.


Admitting representatives also have another critical role – Hospital Loan Officer. Just think, they categorically extend more unsecured credit than you see in any other industry. Every time a patient is admitted or treated as an outpatient without paying in advance 100% of the charges in cash, credit is extended. The only collateral is an insurance card, Medicare/Medicaid card, verified coverage or maybe a promissory note – no collateral. It is billions of dollars each year in unsecured credit.


Sometimes non-resource patients apply for charity care. This requires an extensive application process involving proof of income, ability to pay, proof of residency and other components. Sounds like a credit application to me. It is typically initiated and often completed with the guidance of an access representative.


Suffice to say that the role of access professionals in the healthcare delivery system is extremely important! They are the first impression and they have everything to do with getting paid. If that is the case, one might speculate about the recruiting practices, on-boarding, pay scale, training, schedule and many other items used to ensure that these functions are conducted effectively. The expectation would be that these positions would be highly trained and well compensated. If that is not the case, the organization may have a difficult time competing. Let’s face it, it is has been traditionally difficult for hospitals to maintain an access team that “wows” the public but still minds the purse strings. Those folks are hard to find and keep.


My thought here is not so much to talk about what we are doing now – you probably already know that about your organization. I offer the idea that hospitals should consider recruiting admitting personnel with banking or credit screening experience. The characteristics banks, lenders and screening companies are after include:


– Detail orientation and thoroughness


– Professional appearance


– Articulate, good interpersonal communication skills


– Computer savvy


– Comfortable asking for personal information and money


– Sensitivity in face to face encounters


– Ability to say “no” when necessary


– Knowledge about basic financial practices and ability to apply specific policy


– Commitment to confidentiality


– Tolerance to work with a diverse public


– Willingness to initiate problem escalation


I submit that hospitals might be well served to weigh these characteristics and non-hospital experience that requires these characteristics more heavily than healthcare experience when hiring entry level admitting staff. This practice expands the labor pool beyond those with healthcare background and ensures that fundamental qualities are present among the candidates. It is much easier to train a new hire in the nuances of hospital policy and procedure than to teach them the things listed above.


At Nearterm, our Patient Access Consultants have introduced and implemented this kind of thinking successfully in many provider organizations. This process typically starts with assessment of the access system and advances to a conceptual design, work plan and implementation. We also advocate other hiring practices that are “outside the box” both for our clients and internally. Related innovations we have facilitated are remote verification, pre-admission and financial counseling.
Our Healthcare Search Professionals work with clients daily as we partner to re-invent hiring guidelines designed to attract the kind of talent they need. We are always available to discuss patient access, admitting and registration issues with hospital revenue cycle managers.

Posted By: Nearterm Houston

Work claim edits remotely – a great idea for many hospitals.

We all want to handle claims only once. We do all we can to preclude denials. But when you categorize the reasons your scrubber rejects claims, you find that in order to resolve that prioritized list, many disciplines have to get involved e.g. coders, clinicians, charge master, and perhaps the patient. Often more than one of these disciplines is involved so that tracking resolution progress becomes a challenge. That said, most hospitals find that a credentialed coder can quickly resolve a high percentage of edits. Coders are in high demand and short supply so therein lays a challenge in many communities.

One hospital has addressed this challenge by using remote coders to manage claim edits. This is different than the commonly used practice of remote coding because the work volume includes only rejects, not initial charts and the work list is generated out of the billing system. All claims “kicked out” by the billing edit system for a coding-related reason are routed electronically to a remote coder who has access to facility records via VPN. Claims are resolved same day and returned for billing. The hospital has captured the following benefits as a result of this protocol:


    • Claims are turned around for billing immediately instead of enduring a routing process in the hospital. The hospital gets paid faster.


    • There is little or no allocation of hospital based coder time to respond to billing requests. Vacancy, vacations, volume swings and other factors driving the availability of hospital based coders to work on claim requests are no longer a problem for billing.


    • It is a cost effective way to access professional coding time. As volumes fluctuate from day to day, utilization of the remote coder time fluctuates proportionately.


  • Remote coders can focus on identification of patterns and recommend solutions easily because they are focused only on claims that have rejected. They might recommend charge master updates, new coding practices, physician education and/or many other ideas.


The process is very easy to implement and there is no start-up cost. If you are already using remote coders to work your edits, please share your experience with us. If you are considering it, please feel free to contact Nearterm and we will be happy to explore the details with you.

Posted By: Nearterm Houston

Too busy to look at patient accounts?

I actually thought I was that busy myself early in my career. After all, there was a hospital budget to prepare, a seemingly unending stream of meetings to attend, performance appraisals to complete, AR reports to produce/review, a conversion right around the corner and a myriad of other priorities.
Then one day I was asked, “What is the work product of the revenue cycle organization that you manage?” That’s an easy answer, I thought….it is 3 things-cash, patient satisfaction and cost effectiveness. Then came a lightning bolt that said those 3 things are certainly objectives but they might not be the work product. I asked myself what I could do to ascertain that the revenue cycle team was doing the things every single day that help us achieve those objectives. Conclusion; look at accounts and think of that as a review of our work product. Include that as part of my management practice.

The protocol was more than a look at random accounts. Reports were designed that queued a specific stratification of patient type, payor, balance range, age and alpha split at intervals that would provide me with statistically meaningful samples.


I scheduled 3 consecutive hours each week to shut my door and review the designated accounts. The review was a discovery process so I looked at almost everything in each account history. When problems and/or questions came up, I would either call whoever in my organization was responsible, ask them to pull up the account and review it with them or else post a note to the account requiring a response. I was in a leadership position and had a lot of employees in several facilities reporting to me so these calls and notes came as a surprise to many until word was out that I had embraced this practice.

If I had to single out a management practice that effectively helped us improve revenue cycle performance and accountability, review of work product would be it. A number of positive things happened relatively quickly when this protocol was implemented. Here are a few examples;
    • We learned that many of the things we thought we were doing were not really being done consistently or in some cases at all. By surfacing these items, we could address them. You can’t fix what you don’t know about.
    • The entire organization, not just the management team, became engaged in problem solving. When account history patterns surfaced, the people doing the work typically had the right solutions but had not been asked for their ideas before.
    • It became apparent throughout the revenue cycle organization that account documentation was of critical importance. When I would call an AR technician to ask why no work was documented on an account, the response was often that the work was done just not documented. We had a teaching moment to reiterate “If it is not documented, it was not done”.
    • Managers who reported to me were out of touch with the work product of their employees. When I personally began to get involved at the detail level, they quickly realized they had better do the same. When I identified a problem by talking with one of their staff, I would then contact the manager to discuss the problem and how we might solve it. It was not long until they too began account reviews similar to the ones I was doing so that they could identify and bring opportunities to me rather than their folks telling me. They were a very good team when we started and were even better as a result of this practice.
    • I had always talked and written internally about what was important in our organization. However, I don’t think people embraced my guidance about what was important until they saw that I was investing my time focusing on lag times, wait times, quality of calls, frequency of contacts and other things I could see by looking at a patient account. As I shared in a previous BLOG, people decide what is important based on how we spend our time, not what we say or write in memos.
  • The whole process was not only revealing and educational but it was also fun! I got to know the people doing the work a lot better and enjoyed the collegial approach that grew from the process. I got a lot closer to the people in my shop.

As a revenue cycle strategist, I am critical of senior managers who are not attuned to the details of their operation. Patient account managers have to have a mechanism and the discipline to know what is happening in their offices.

Posted By: Nearterm Houston
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