Category Archives: RCM Consulting Services

As a leader in Healthcare Revenue Cycle Management Consulting, Nearterm is uniquely positioned to offer insight & solutions to common RCM challenges.

Pygmalion In Revenue Cycle Leadership

The Pygmalion Effect on Revenue Cycle Leadership

The Pygmalion Effect can be described as the phenomenon whereby higher expectations lead to an increase in performance.

Much has been written about the Pygmalion Effect. The concept is controversial. However, like most controversial concepts, there are elements of validity that can be applied successfully in the workplace and particularly in Revenue Cycle Management. Consideration of this idea requires understanding that it is not as simple as arriving to work with high expectations and leaving that night with record performance improvement as a result of your expectations. On the contrary, it is a leader’s behavior expressed to followers over time that can affect the behaviors of followers. The more an employee is engaged in learning activities, the higher the expectation from the leader. In turn, the employee participates in more learning behavior and leaders then tend to gain the level of trust, respect and confidence that leads to process innovation and performance improvement.

By way of illustration, consider this passage from George Bernard Shaw’s play, Pygmalion:

“You see, really and truly, apart from the things anyone can pick up (the dressing and the proper way of speaking, and so on), the difference between a lady and a flower girl is not how she behaves but how she’s treated. I shall always be a flower girl to Professor Higgins because he always treats me as a flower girl and always will; but I know I can be a lady to you because you always treat me as a lady and always will.”

Some managers always treat their subordinates in a way that leads to superior performance. But most managers, like Professor Higgins, unintentionally treat their subordinates in a way that leads to lower performance than they are capable of achieving. The way managers treat their subordinates is subtly influenced by what they expect of them. If managers’ expectations are high, productivity is likely to be excellent. If their expectations are low, productivity is likely to be poor. It is as though there were a law that caused subordinates’ performance to rise or fall to meet managers’ expectations.

Here’s the reveal about how expectations impact people in the workplace:

  • What managers expect of subordinates and the way they treat them largely determine their performance and career progress.
  • A unique characteristic of superior managers is the ability to create high performance expectations that subordinates fulfill.
  • Less effective managers fail to develop similar expectations, and as a consequence, the productivity of their subordinates suffers.
  • Subordinates, more often than not, appear to do what they believe they are expected to do.

If you are interested in this concept and would like to discuss it further, I would welcome your call. Nearterm provides Revenue Cycle thought leadership to a national base of clients, peers and colleagues.

Posted By: nearterm-admin

Use a Cash Acceleration Team to Optimize RCM

7888_cash_acceleration_team1

There are many explanations for sluggish cash performance and obviously, understanding causes may be useful in preventing recurrence. Meantime, you have a backlog and the objective is to get caught up. That’s where a Cash Acceleration Team can be helpful.

What is a Cash Acceleration Team? It is a highly customized temporary external resource allocation of seasoned professionals with the right credentials, experience, and skillset to help you get current on your collections and stay there. A team might include Coders, AR Specialists, Billers, Collectors, and Auditors, among others. The size of the team depends mostly on volume, the scope of work and how quickly the organization wants to capture an expressed opportunity but other factors may come into play as the team is customized and designed. Team resources can work remotely or at your facility or some combination.  Successful teams are closely managed and can redirect focus as project demand dictates.

Nearterm can work with you to build just the right team. We’re experts in Revenue Cycle Management (RCM) and our Cash Acceleration Teams are a proven solution for helping your facility achieve its cash collection targets faster and with less effort.

Posted By: nearterm-admin

ICD-10 Changes for 2017 Make RCM Even More Critical

October 2016 brought major changes in the ICD-10, and annual updates to the coding system will be the norm once again.

October 2016 brought major changes in the ICD-10, and the freeze is over. Going forward, annual updates to the coding system will be the norm once again. Keeping up with ICD-10 changes will be an ongoing challenge, making RCM even more critical to maintaining and increasing your profitability.

RCM Challenges

Hospitals and physician practices face a number of challenges in effectively managing the revenue cycle, including:

Patient Access

Patients are becoming more assertive in terms of deciding when and where to receive health services. As a result, health care organizations need to have clear and effective patient access processes in place. New patient registration, insurance verification and accurate billing are more critical than ever before.

Billing and Collection Errors

Billing and collection errors are a large source of lost revenue. This issue is even more critical as the coding schemes change. Improper coding not only delays revenue, but without accurate tracking, payment may never be received.

Collection errors are becoming more common as responsibility for payment changes. Patients are increasingly responsible for more out-of-pocket costs, and insurance providers have a dizzying array of payment levels depending on the policy terms.

Monitoring the Entire Claims Process

It is only possible to catch and correct billing and collection errors when processes are in place to monitor the claims process from beginning to end. Hospitals and physician practices need to invest in technology to track claim metrics and prevent problems.

RCM Action Items

Focus on Staff Training

Every staff member within a health care organization needs to have a working knowledge of patient and insurance payment issues. However, staff members who are directly responsible for managing patient access and coding must understand the importance of the information they deal with.

Getting the right information when a patient is registered lays the groundwork for the entire revenue cycle. In addition, coders need training that will keep them focused on staying accurate even as ICD-10 changes take place.

Establish Clear Patient and Insurance Company Communications

Sensitivity is required to communicate with patients concerning their financial responsibility, but clear upfront communications certainly help. You can pre-register a patient by collecting the information you need to verify their insurance coverage when an appointment is scheduled.

Contact the insurance company to verify the patient’s coverage, and to identify requirements for copayments, coinsurance, deductible amounts and out-of-pocket maximums. Estimate the amount the patient will need to pay and have an open discussion with them about their financial responsibility and the options that are available to them for making payment.

Take Advantage of Technology

Managing the claim process from beginning to end can be a strain on your staff. Use technology wherever possible to improve processing accuracy and reduce the burden on employees.

When you have an automated system in place, be sure to track the critical metrics that will help you troubleshoot your processes and collect all the revenue to which you’re entitled. Important metrics include:

  • Insurance company denials – Track the percentage of denials for each insurance company. Work to reduce these percentages by identifying and fixing problems that are causing denials.
  • Copays collected when service is provided – Once they leave your facility, the odds of collecting from patients go down precipitously. Accurately estimate patient responsibility and work with patients to process payment at the time of service.
  • Collection as a percentage of gross charges – Tracking collection ratios for both patient and insurance company billing will let you know where there are opportunities for improvement.

Operations may be getting easier now that the major updates to ICD-10 have been made, but ongoing changes are inevitable. The time is right to review your revenue cycle management systems to ensure that you’re on the right track moving forward.

If you have questions, we’re here to help. Feel free to get quick answers by submitting your question to Ask the Experts.

Posted By: nearterm-admin

A Deluge of ICD-10 CM/PCS Codes is Coming to All Healthcare Facilities: What to Do?

Jim Matthews  ICD-10 CM/PCS
Jim Matthews, Principal, Nearterm Corporation

On October 1st of this year, a deluge of over 5,000 new ICD-10 CM/PCS medical codes and other changes are coming to hospitals and clinics nationwide. The stakes are high so it is important to get it right the first time. Errors may lead to delayed or denied claims, negatively impacting the revenue cycle management process and, therefore, cash flow.

On top of that, complying with ICD-10 CM/PCS requires a substantial investment in education and technology, pushing the stakes even higher.

Below, Nearterm offers suggestions on what hospitals can do to mitigate the impact of ICD-l0 CM/PCS. The big one is to create a Plan of Action (POA) to uncover and address shortfalls and unpreparedness in all RCM functional areas.

HIM Management

  • Develop a POA. Determine the level of quality and sufficiency in current coding and documentation processes by doing a formal discovery and assessment. Research might reveal that a Clinical Documentation Improvement (CDI) program is needed or should be All relevant Changes to PracticeWork Flow and Business Processes should be covered in the POA.

Medical Coding & CDI

  • Ensure all Medical Coders and CDI specialists are trained on the new/revised codes and how they may impact current business
  • Update CDI and Medical Coding policies to include directives on the new codes if applicable
  • Follow up weekly with Coders and CDI specialists to discuss specific code sets/procedures that may require updating current Queries.
  • Ensure that you have a point person assigned to regularly check coding for quality

Physicians & Practitioners

  • Physicians must be vigilant and ensure that all documentation remains at a high level of specificity
  • For high impact surgeries and diagnoses, complete a 5-to 10-chart/ provider documentation review to ensure the documentation supports the highest level of specificity
  • Include the physicians and practitioners in the audit results and provide education on documentation opportunities that support the severity of illness of their patients.

Billers

  • Billers should also become familiar with expanded ICD-10 code sets for the specialty for which they bill
  • There will likely be snafus related to reimbursements. How to create referrals and order services IS going to change. Effective October 1, 2016, Medicare will no longer accept unspecified codes for Part B. Have the POA include ways to prevent these accounts from being billed before a second level coding review can be done.

Outpatient

  • In the outpatient hospital side, queries may have to be sent back to the ordering provider requesting specificity either before the patient is seen (at registration) or at the time of coding for final billing

Vendors

  • Do not forget to make sure that vendors are up to date and ready for the expanded codes on October 1, 2016.

About Nearterm

Established in 1997, Nearterm is an employee-owned, professional managed services company providing expert revenue cycle management (RCM) and financial management services to hospitals and healthcare organizations nationwide.

Nearterm specializes in the delivery of additional “horsepower” for implementing and supporting RCM activities and projects. These resources can work from remote locations and/or onsite, whatever hospital and the POA requires of them. Nearterm delivers only top notch talent;

  • Consulting (Discovery, Research, Analysis, Planning, POA, Implementation Support
  • Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Technicians (AR Specialists, Coders)

Nearterm is a recognized authority in Revenue Cycle Management

 

Posted By: nearterm-admin
Managed RCM
Services