Top Healthcare and Revenue Cycle Trends to watch for in 2018

2017 required healthcare organizations to respond to several new challenges – political change, growing role of technology, shift to value-based care and the increasing role of information security. While we anticipate that these issues will continue to influence through 2018, we will also see new challenges. The blurring lines between providers and payers, a refocusing on care (and more so on the patient), and a changing policy environment will occupy the center stage for 2018.

Here are some of the top trends that we believe will be in focus in 2018:

1. IT'S IN THE CLOUD!!!

If your revenue cycle management system is not in the cloud today, it should be soon. Top revenue cycle management systems are offering their platforms via cloud-based technologies with interesting features that enable practice leaders to view performance across different KPIs. This technology has turned out to be a key disruptor over the past 6-8 years. In 2018, we will see cloud-based technologies becoming more of a norm than an exception, especially in the physician revenue cycle market.

2. THE MACHINES HAVE GOTTEN INTELLIGENT AND ARE READY TO HELP YOU WITH YOUR FRONT AND BACK-OFFICE NEEDS. 

The hype around robotic process automation has given way to artificial intelligence and machine learning-based technologies to a level where they can be harnessed to provide sustainable efficiency gains in back-office operations. Whether it is utilizing tools such as screen-scraping or utilizing machine learning to understand the payment cycle of payers, process automation technologies are here for good. 2018 will pave the way for intelligent automation, often preventive in nature, to change front-office technologies pervasively.

3. CARE IS ABOUT THE PATIENT - TIME TO REVISIT THE BASICS

Patient experience will become a top priority in 2018. As the back-office shifts to offshore and machines, there will be investments and a new focus on improving the patient experience through preventive care outreach, through registration and care at the healthcare system, discharge, and post-discharge coordination. Ultimately, we will see a significant change in the role of the front office.

4.HEALTHCARE REFORM

According to market watchers, the biggest potential disruptor could be a change in healthcare funding for Medicare / Medicaid programs.

5.ARE YOU DELIVERING VALUE?- A QUESTION THAT ALL HEALTHCARE MARKET PARTICIPANTS ARE GRAPPLING WITH

The role of each participant in the healthcare value chain begins to get questioned in the value-based payment models. As the lines blur between payers and providers, we see intensified activity from mergers and acquisitions, some as game-changing as the CVS-Anthem mega deal. 

6. ROLE OF SECURITY TECHNOLOGIES

As with all businesses worldwide, Healthcare businesses will be forced to contend with cyber-threats. Cybersecurity vulnerabilities in medical devices could lead to erroneous medical observations, leading to the need to have comprehensive information security program.

7. IT’S ABOUT ANALYTICS!

The impact of social and demographic variables on the health of a population segment will drive the need for focused local and long-term fixes, leading to a healthier population.

8. PRICE TRANSPARENCY- ADDRESSING TOTAL COSTS OF CARE

Increasing price transparency -either through legislation or through market-making apps, will force healthcare payers to go for non-traditional partnerships to reduce total costs of care.

9. HEALTHIER POPULATION

There are several factors at play when we say we will see a healthier population in 2018. Increased copays and deductibles could force youngsters to adopt a healthier lifestyle. We could see a significant push for preventive care by healthcare payers who are getting more involved in the health of their members. Additionally, a rise in peer pressure and awareness for a healthy lifestyle and medical devices could be another indicator. For these reasons, we are confident that America will see a significantly healthier population in 2018.

10. INCREASING DEMAND FOR THERAPY SERVICES

The Opioid Crisis has sparked a national debate. With as many as 150 estimated drug overdoses each day, we anticipate more regulations coming to opioid prescription drug distribution. We could also see services such as rehabilitation, behavioral, and occupational health therapy to rise in 2018.

About the Authors:

• Manish Jain is Chief Marketing Officer at Access Healthcare. He can be reached at manish.jain@accesshealthcare.co 
• Scott Schrader is Chief Commercial Officer at Access Healthcare. He can be reached at scott.schrader@accesshealthcare.co

9 things to look for in a Revenue Cycle Outsourcing Services provider

Outsourcing your revenue cycle to a seasoned services provider can help improve both your top as well as bottom line. However, the choosing the right service provider can be a tricky and requires careful consideration. Here are a few traits that your revenue cycle services provider should demonstrate:

1. Focuses on improving your revenue through compliant processes
2. Lowers your cost to collect
3. Helps you stay compliant with regulatory norms and improving quality
4. Deploys a trained workforce
5. Manages by the numbers — focuses on revenue cycle KPIs
6. Ensures effective follow-up with payers
7. Automation. Automation. Automation. 
8. Helps you scale your business
9. Collaborates effectively and is transparent in reporting the facts

Selecting the best-fit revenue cycle management services provider is critical to your organization's success. When denials go up, bad debts and loss of revenue become a major financial burden for providers. Remember that when you are looking to outsource your revenue cycle processes, you are looking for an expert, and you should choose wisely. A service provider that brings the right people, process, and technology together to streamline your revenue cycle will elevate your organization to the next level and bring forth not only just efficiency but also financial opportunities.

Read the full whitepaper here:

About Access Healthcare

Access Healthcare provides business process outsourcing, applications services, and robotic process automation tools to healthcare providers, payers, and related service providers. We operate from 12 delivery centers across US, India and the Philippines. Our 8,000+ staff is committed to bringing revenue cycle excellence to our customers by leveraging technology, emerging best practices, and global delivery. Based in Dallas, we support over 150,000 physicians, serve 80+ specialties, process over $ 50 billion of A/R annually, and ascribe medical codes to over 10 million charts annually. To learn how Access Healthcare can help your organization boost its financial performance, visit accesshealthcare.org.

Scaling up revenue cycle BPO operations – Lessons from our experience

Faced with the daunting task of deploying over 1,000 people with healthcare industry knowledge and experience, Access Healthcare’s recruitment, training, and operations team had to think differently. The team had to react fast and develop multi-pronged approach including leadership participation in the hiring program, utilization of automation tools for hiring, selection and training, creating a lucrative referral program, and strong brand messages. We bring you lessons from our experience of building a 1000 people operation in less than two months in a completely new city.

1. DRAW UP AN EFFECTIVE SOURCING STRATEGY

An effective talent sourcing strategy must necessarily consider the complexity of the process, time to train resources, the pace mandated by the customer to transition the process, and quality service levels committed to the customer. To achieve a seamless transition, the sourcing, operations, and training teams need to collaborate. Involving stakeholders from the customer’s side, wherever possible, will ensure a greater appreciation of the risks and challenges as you strive to migrate a large-scale process.

2. HIRE AND DEPLOY THE RIGHT SET OF LEADERS

As we were embarking on setting up a new center in a completely new city, finding the right set of leaders was of utmost importance, and, even more important, was to hire these leaders ahead of the schedule. Hiring and deploying the local leadership team early on can accelerate souring efforts. Given a short timeline to hire and ramp-up the team, we had just 15-day time to ensure that these leaders were inducted and aligned to the organizational objective of a quick pace hiring.

Winning the Trust: The recruiters oriented the initial seed team hired during the first week, about Access Healthcare - our culture, service offerings, growth strategy, achievements, and people programs. All these factors helped in turning them into brand ambassadors for Access Healthcare in the new city

3. GET THE WORD OUT - SOCIAL MEDIA AND PERSONAL OUTREACH

Often, your best bet is to involve your leaders to accelerate hiring processes. Being an unknown brand in the city with an office infrastructure that was still being built out, the authenticity of the new employer will get questioned. To address this band gap, we involved the newly hired leaders to accelerate our brand messaging, set up a call center to reach out to identified candidates, initiated a social media reach out effort, and circulated organizational collateral. With consistent messaging on available job opportunities, history and pedigree of the promoters of the company, questions from prospective employees were addressed. 

Unified communication that includes web and social updates, text messaging along with in-person and word of mouth communication via the leaders on-boarded early in the cycle, can help amplify the impact of your hiring message.

4. AMPLIFY YOUR PEOPLE BRAND THROUGH A STRONG REFERRAL PROGRAM

Job portals are seldom as effective as “word of mouth” or social outreach. A quick decision on lucrative referral bonuses ensured that the leaders and revenue cycle specialists being on-boarded into the company spread the word about the organization and growth opportunities. Nothing works as effectively as an aligned team when you are looking to onboard resources quickly.

Refer and Win Application. Differentiated social hiring strategy leveraging our Refer and Win App on the company’s Facebook page enabled our followers to participate in the referral program as well. All successful referrals were rewarded quickly. Further, we utilized location-specific advertising on Facebook to mobilize job candidates as well as those interested in referring people to work for Access Healthcare.

5. SUPPORT YOUR FRONT-LINE RECRUITERS WITH A BACK-END REACH OUT TEAM

Revenue cycle specialists are hard to find. When you are looking to hire top-notch talent, it is imperative that you can address their queries about your organization and growth opportunities that you offer. We supplemented our front-end hiring team’s reach out efforts with a back-end call center and processing team to address questions from candidates and handle the administrative work of generating e-offer letters.

6. ENSURE QUALITY THROUGH AN AUTOMATED TESTING AND SELECTION PROCESS

As a BPO organization, Access Healthcare often hires 100's of candidates in a month - with a yield rate of less 10%. Hence, we had to create an automated engine that enabled effective testing of the aptitude, skills, and revenue cycle knowledge of prospective employees. arc.recruit, Access Healthcare’s proprietary technology includes functionality to screen resumes, schedule interviews, promote our employee referral programs, facilitate testing and selection processes, generate e-offer letters, and coordinate with the on-boarding teams. With over 850 employees to be hired within 30 days, managing the entire recruitment life cycle of identification, testing and selection could have been a daunting task. However, arc.recruit enabled us to streamline the entire recruitment life cycle and support our growth agenda.

7. SUPPORT YOUR SOURCING TEAM WITH EXECUTIVE PRESENCE AND LUCRATIVE INCENTIVES

When managing a high-volume hiring program, it is imperative that the sourcing team does not drop the ball at any time during the sourcing cycle. Outreach efforts often run into extended hours as the candidates are more likely to pick calls after office hours. Therefore, a good incentive program can boost the morale of your sourcing team and help you achieve your business goals. Our sourcing team observed low results in the first week and could have easily given up. Active participation in the sourcing efforts by Access Healthcare’s leadership team, combined with the reach out efforts of the local leaders on-boarded early in the cycle ensured significantly better results from the second week and kept the morale high.

8. RECOGNIZE THAT OFFSHORE REVENUE CYCLE TRAINING IS SPECIALIZED

Large-scale hiring programs also necessitate a re-look at your training programs. On one hand, you may be hiring individuals with revenue cycle processing experience, on another hand, you may also have individuals without experience. Different approaches are needed for people with and without experience. While experienced candidates need to be assessed for their familiarity with the processes being transitioned, inexperienced candidates need to go through a more detailed training program. Process transition leaders need to bear in mind that the ramp-up of experience resources will be faster than the inexperience resources. Modularized training programs can provide transition managers the flexibility to balance productivity goals with the pace of ramp-up. In exigent situations, some of the modules could potentially be staggered over the initial weeks to allow production processes to commence earlier.

9. GRADUALLY IMPROVE QUALITY AND PRODUCTIVITY TARGETS

New hires deployed on a customer’s revenue cycle processes usually take as many as three months to achieve full productivity level. While hiring experienced candidates can potentially shrink the dramatically, you may not be lucky enough to find them. As you strive to achieve the service levels committed to customers, a graduated reduction of quality samples being checked for new hires from 100% to 20% over three months has proven to be an effective strategy. Also, the production targets for the new hires also need to be gradually increased. As the team ramps-up, team leaders and process trainers need to analyze the errors committed by the new team and provide right interventions to improve overall process knowledge.

10. GET EXECUTIVE BUY-IN

A large-scale hiring program can only be successful when there is a demonstrated involvement of senior executives of the organization. This enables quicker decision making on the design of the sourcing programs, incentive structures for referral program and the sourcing team, besides enabling them to effectively communicate the risks and challenges to customers, and, if needed, realign customer expectations.

OUR STORY - BY THE NUMBERS,

About the Authors

• Magesh M, Director - Human Resources - Talent Acquisition, has over a decade of experience in recruitment processes including alignment of sourcing strategy with business goals, strategic planning & implementation, the design of recruitment processes, managing sourcing teams and process automation. He can be reached at magesh.m1@accesshealthcare.co 
• Yoganandan R, Lead Director - is an accomplished operations leader with experience in revenue cycle business process services delivery, process migration, quality and compliance, and managing customer relationships. His core areas of specialization include account management, service delivery, and operations excellence. He can be reached at yoganandan.r@accesshealthcare.co

About Access Healthcare

Access Healthcare provides business process outsourcing, applications services, and robotic process automation tools to healthcare providers, payers, and related service providers. We operate from 12 delivery centers across US, India and the Philippines. Our 8,000+ staff is committed to bringing revenue cycle excellence to our customers by leveraging technology, emerging best practices, and global delivery. Based in Dallas, we support over 150,000 physicians, serve 80+ specialties, process over $ 50 billion of A/R annually, and ascribe medical codes to over 10 million charts annually. To learn how Access Healthcare can help your organization boost its financial performance, visit accesshealthcare.org.

How not to lose money when you migrate to a new revenue cycle system

EXECUTIVE SUMMARY

The consumer landscape has changed dramatically over the last two decades, and the healthcare space has seen several such changes including impact of ICD transition, proliferation of cloud-based revenue cycle providers, changes in the products of health plans, and not to mention, the need to do more with less on account of reducing reimbursement rates. 

System transitions are one of the most significant causes of lost revenue in Provider revenue cycle management. As salespeople reach out to you to make a quick decision to switch your core revenue cycle management platform, you as a decision maker need to carefully evaluate if your decision could potentially have an adverse impact on your financials. Whether you are a physician practice or a revenue cycle services provider, you need to take time to consider the implications of the system transition and, more importantly, put in place a comprehensive right set of change management processes to achieve a successful revenue cycle system transition. 

Migrating revenue cycle platforms requires a careful consideration of both IT and business needs, and challenges. While the new platform providers typically enable a smooth systems implementation from a technology perspective, more often than not, they give you options around a cutoff date prior to which the revenue cycle data is not migrated. 

Furthermore, most of your internal staff is focused on transitioning to the new system. With a lack of clear guidelines on write-offs, persistent follow-up on aged A/R and lack of focus on ensuring that revenue cycle processes are consistently run on both systems, issues such as reduced reimbursement, physician dissatisfaction, client exits, and lost revenue often creep up. 

Effective collaboration between your revenue cycle systems provider and business process outsourcing (BPO) partners early in the transition can help address issues such as loss of data from the old to the new platform, ineffective follow up of old A/R balances, ineffective linkage of EMR records with patient data, and loss of patient data or the reimbursement history. Therefore, the importance of a strong governance model through the transition cannot be undermined. 

In this paper, we examine the key challenges of transitioning to new revenue cycle platforms and provide best practices from our in-depth experience across multiple platforms and supporting over 25 clients.

INTRODUCTION

For Healthcare providers, it is important to improve reimbursement rates while continuing to be compliant with the regulatory requirements. While new revenue cycle platforms offer an opportunity to reduce work effort in the practice as well as the back-office, system transitions often result in lost revenue and excessive costs of transitions. 

Migrating an existing revenue cycle processes to new platform poses a unique set of challenges. For effective RCM platform transitions, effective integration of IT and business process transition would help in the elimination of revenue leakage and effective transition of elements such as:

1. Patient Information and Charges

• Ensure that the Patient data is migrated to the new platform. This will improve effectiveness of the new system being implemented 
• Ensure new charges are entered into the new system from the date of switchover

2. Accounts Receivable

• Transition Aged Accounts Receivable information data transition based on the agreed cutoff date 
• If you are migrating partial A/R data, ensure medical history and associated records are migrated for the accounts with balances 
• Ensure availability of the old RCM and EMR system to run out A/R effectively

3. Medical Information

• Medical history and EMR information should be carefully transitioned with strong governance and oversight

ACCOUNTS RECEIVABLE RUN DOWN STRATEGIES

Revenue cycle managers should work with the chief financial officers to decide on the time period for which a collections effort needs to be initiated, the method to value the aged A/R balances, guidelines for write-offs, and choice of the right partners. Some of the most critical elements in running down aged A/R balances are the following:

A. PREPARING FOR TRANSITION

i)   Ensure Credit balances are cleared as much as possible prior to the migration 
ii)  Ensure that the files related to the remaining credit balance are available for future processing

i)   Valuing Aged A/R is as much an art as it is a science 

ii)  Information on historical success rates with collecting A/R by aging bucket, timely filed claims, and by payer can help in valuing the aged A/R correctly 

iii)  Get expert help for valuing A/R 

i) It is important that you work your A/R backlog off the old system. Irrespective of the switchover date, there is a good possibility that information required to support your claims may not be transitioned perfectly. This will enable stronger recovery  

i)  Since EMR Systems are often transitioned along with the RCM systems, an ineffective transition may lead to medical records not being available once the system is migrated. Therefore, transition managers need to ensure that the medical records associated with RCM/EMR system migrations are available to the teams handing A/R run down project 

ii)  Legacy AR data should be available for any backtracking and audits 

iii) Payment reconciliation and availability are key to ensure a smooth transition.

B) PURSUE A/R STRATEGICALLY

Go after the low hanging fruits
Define priorities based on thorough analysis of outstanding AR

i)   Low hanging fruits: Dissection of A/R by payers and by date of service will give you a clear view of the accounts that are most likely to get paid. Create a SWAT team to chase this set of accounts and track progress aggressively

ii)  Very old A/R: The time period for which a collection/run down effort needs to be initiated needs to be planned carefully. Very Old A/R balances have very limited chance of success

iii)  Low Balance: Clearly understand the cost to collect and take a decision on writing off old A/R where the cost of collections is more that amount likely to get recovered. Decide to adjust the old AR where the cost of collections is more than the actual collections

Define the policies for operations team
i)   Define the policies for tracking effectiveness of the A/R run down effort 
ii)  Address every claim at least once to maximize collections 

iii) Set goals and track aggressively 

iv) Track progress of old AR – Collections & Reduction of outstanding AR 

v)  Define write off policies. Clearly, understand the cost to collect and take a decision on writing off old A/R where the cost of collections is more that amount likely to get recovered 

vi)  Ensure there is governance through the run-down effort

Get a specialized team

There are different ways in which Revenue Cycle Managers can look at addressing old A/R at the time of system migration

i)  Existing Staff: Utilizing existing staff is an obvious choice but it is often not the most effective one. Platform migration being a complex project typically drains out resources and drives focus on business as usual vs. the old A/R. 

ii)  Utilizing a BPO vendor: Choice of BPO vendors should be dependent on their ability to resolve A/R rather than just obtain statuses of the balances. Resolution of each account may require a lot more interaction with internal stakeholders during platform migration than is normal. Contracting could be for a contingency fee or for touching up each account. Contingency fee models could be developed based on total A/R collected by the vendor. 

iii) Factoring Services: Several Healthcare RCM services providers offer factoring services.Choice of factoring services provider should be done only after the A/R has been diligently valued. As mentioned earlier in this paper, valuing A/R is an art and hence, choose your service provider carefully

  

About the Authors:

• Sanjeev Britto, Vice President of Operations, With over 13 years of experience in the delivery of revenue cycle processes, Sanjeev leads the delivery of best practices to over 40 Access Healthcare Customers. He can be reached at sanjeev.britto@accesshealthcare.co 
• Manish Jain, Chief Marketing Officer. Manish brings over 15 years of experience in solution design, sales, and marketing supporting healthcare and financial services customers. He can be reached at manish.jain@acceshealthcare.co

About Access Healthcare

Access Healthcare provides business process outsourcing, applications services, and robotic process automation tools to healthcare providers, payers, and related service providers. We operate from 12 delivery centers across US, India and the Philippines. Our 8,000+ staff is committed to bringing revenue cycle excellence to our customers by leveraging technology, emerging best practices, and global delivery. Based in Dallas, we support over 150,000 physicians, serve 80+ specialties, process over $ 50 billion of A/R annually, and ascribe medical codes to over 10 million charts annually. To learn how Access Healthcare can help your organization boost its financial performance, visit accesshealthcare.org.