The new age of revenue process management and opportunity

Technology continues to advance rapidly, allowing us to best serve our patients and make quality healthcare more readily available. For hospital operations, we are just now beginning to embrace the opportunities of technology. “Technology investment,” is the fastest-growing opportunity (that many will miss) with the most significant impact at a time where we are seeing:

  • Healthcare costs on the rise
  • Mergers and acquisitions being maximized
  • Rural healthcare closures are rapidly increasing
  • Bundled payment models are increasing
  • Increase of the cost of equipment and innovation
  • Decreased reimbursements
  • Increased physician practice acquisitions
  • Increased physician employment models
  • Revenue instability and A/R disruption

The term “revenue cycle” is definitely outdated. Revenue Process Management, a more valuable term, denotes that we are no longer in a cycle of perfect order where one task is completed, and then another started. The inefficiencies cost hospitals and healthcare systems millions each year.

The acceleration of technological advancement, paired with rising healthcare spending, are the key factors driving the growth of the healthcare revenue cycle management market, which is projected to be worth $104 billion globally by 2025, according to

Hospitals are beginning to shift towards outsourcing some of the expertise needed to embrace the new technologies which can increase the accuracy, efficiencies, and revenue. The biggest reason for slow adoption is fear. Automation and software often create immediate resistance to change and adoption. Yet the revenue  process is directly related to speed and accuracy. Many people are already maxed out with regards to workload. Adding additional work and complexities decreases accuracy, prolongs time, and increases the cost. The technology and software, if utilized correctly, alleviates this pressure and optimizes the workflow.

The best example is the proposed Alternative Payment Model for radiation oncology. There is currently one month left in the comment period. Three years of data must be reviewed, and this data must be modeled using a regression model approach. For many, this becomes a manual task that ends up costing far more than the software approach would have been and will be far less accurate. Inaccurate baseline data you results in even more costs because of a lower payment assignment based on the utilization.

Legion Healthcare Partner’s ClaimHealth program is a software that does exactly what is needed within the proposed parameters, formula, and constraints.— ClaimHealth

Revenue Process Management for Oncology requires actual content and clinical expertise. In efforts to save money, CBOs often have staff cover multiple service lines. This appears to “save” money on the front end but actually significantly costs money due to:

  • Prior authorization issues
  • Denials
  • Coding errors
  • Insufficient documentation
  • Missed collections

Legion Healthcare Partner’s revenue optimization review, financial tools, and specific education ensure accuracy at all touch points in the process.

Another misconception is that there is already software that does this. It is important to remember that revenue process management includes numerous software applications, manual entries, and specific rule and guidelines. The specificity of Oncology is no different. The major software vendors are not service-line specific. Expertise, knowledge, and software that can communicate back to those systems, as well as extract the necessary data points, is critical.

Example: Questions About Billing Audits for Oncology

  • Are you reviewing 100% of your data?
  • Are you manually doing this?
  • Are you frequently looking for risk and opportunity?
  • Which EMR or EHR is the data from?
  • Which rules are covered?
  • When were the rules updated?
  • Are the results applicable and digestible?

This is precisely what ClaimHealth does. So, don’t assume someone else is doing it, or there is software already checking and benchmarking your data.

The other aspect that is key for providers, hospitals, and departments to understand is who is viewing the data and what their needs are. Extensive reports are not what most want to see. This is the detailed work that should go into putting together easy to read dashboards for consumption and presentation to the intended audience.

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