Speed to revenue. Every healthcare organization wants to maintain revenue integrity and do it efficiently. As hospitals struggle to control costs for new technologies and related procedures during constant policy updates, financial managers from the CFO on down continually concern themselves with speeding up the hospital revenue cycle. First, there must be an understanding of typical revenue cycle slowdowns to determine proper solutions. Some revenue cycle challenges are tactical, and some are strategic. Hospitals driving up the road of revenue recovery face many challenges. We’ll take a look at some of today’s challenges, and how R1’s Revenue Integrity suites help you drive results quicker.
Becker’s Hospital Review reported last year that, according to a Moody’s Investors Service review, “the median annual expense growth rate was 5.7 percent in fiscal 2017, down from 7.1 percent in fiscal 2016. However, the annual revenue growth rate declined faster, falling from 6.1 percent in fiscal 2016 to 4.6 percent in fiscal 2017. ‘This is the second consecutive year expenses have topped revenues and this will remain the largest strain on NFP hospital profitability through 2019.’”
A review of the Moody’s report news release shows that revenue slowing continues. “Revenue pressures continue to overshadow expense saving initiatives,” says Moody’s Analyst Rita Sverdlik. “While the median annual expense growth rate decelerated to 5.7% from 7.1%, annual revenue growth rate declined faster, to 4.6% from 6.1%.” The report also notes that “another emerging trend is a large jump in hospitals reporting operating deficits and lower absolute operating cash flow in 2017. The medians show 28.4% of hospitals with operating losses, which rose from 16.5% in 2016. The 59% of providers reporting lower absolute operating cash flow is more than double the 24% reported in 2015 and the highest percentage in five years.”
Why is this revenue slowdown happening? A Forbes article examining “Why Major Hospitals are Losing Money By The Millions” laid out the challenges in an article a couple of years ago:
“Relatively flat Medicare payments are constraining revenues. The payer mix is shifting to lower-priced patients, including those on Medicaid. Many once-profitable services are moving to outpatient venues, including physician-owned ‘surgicenters’ and diagnostic facilities. And as one of the most unionized industries, hospitals continue to increase wages while drug companies continue raising prices at three times the rate of healthcare inflation.”
We see this mix of roadblocks in hospital revenue cycles regularly with our clients, two years later, including long-time-claims-related challenges. Denials problems? R1’s industry-leading technology identifies missed, misplaced and miscoded charges and aligns physician and hospital billing functions across inpatient, outpatient, primary care and specialty settings. We’ve seen diagnosis related grouping (DRG) findings result in hospitals being underpaid between 1–5% of Net Patient Revenue despite significant investments to mitigate revenue leakage. To address these issues, we use smart technology and expert guidance to conduct DRG validation with limited IT involvement.
A comprehensive article by the Healthcare Financial Management Association (HFMA) listed several keys toward modernizing your revenue cycle for efficiency, including:
-
- Educating patients
- Offering different payment options
- Charge capture
- Clinical documentation improvement (CDI)
- Computer-assisted coding (CAC)
- Workflow management
Charge capture. Efficiency software. Workflows. That is a good, top-level way to look at improvement points in the complex system within your hospital. External forces also slow down the revenue cycle performance drive by your teams. That’s why R1 solutions are based on a holistic approach. We look at contract mapping on the technology side, then reviews on the human side. Our compliance-focused approach involves working with both hospital staff and physicians and often starts at pre-bill reviews.
Often a hospital faces challenges with Medicare reimbursement. A March 2019 Kaiser Health News article details how “Eight hundred hospitals will be paid less by Medicare this year because of high rates of infections and patient injuries, federal records show. The number is the highest since the federal government five years ago launched the Hospital Acquired Conditions (HAC) Reduction Program, created by the Affordable Care Act. Under the program, 1,756 hospitals have been penalized at least once, a Kaiser Health News analysis found.” Despite protests by the American Hospital Association (AHA), “a quarter of general hospitals with the highest [Hospital Acquired Conditions] rates are punished, even if their records have improved from the previous year.”
Of course, there is much more to review for revenue recovery than HAC rates. R1 maximizes Medicare reimbursement on both a retrospective and prospective basis through our best-in-class Disproportionate Share Hospital Worksheet S-10, and Medicare Bad Debt services.
Challenges continue for hospital financial teams. Hospitals need to find more revenue, and they need to find it faster. Some speed solutions may be found in an analysis of your workflows. You may be getting bogged down as your health records flow between systems. An article in HIT Consultant puts it like this: “While 70% of hospitals have adopted RCM technology, many use EHRs combined with multiple RCM vendors, which can cause significant interoperability and workflow issues, as well as data silos.”
As the HFMA article quoted above also observes, “workflow management tools can drive efficiency by automatically routing issues, such as lack of documentation, incorrect codes, or denials, to the correct department for further examination and response, ensuring the appropriate people address problems and prevent anything from falling through the cracks.”
How does R1 speed up revenue recovery? Using an Enterprise suite with one data set gets you to revenue recovery faster than relying on the entire data set from your hospital IT group. R1 is the only provider combining technology solutions and a highly skilled, expertly trained workforce. We are not a point solution for a single problem, but an enterprise suite of tools to transform even single data sets into your needed deliverables, increasing the speed to revenue you deserve.
With over 20 years of experience, our team commits to providing the highest level of client support to over 1,700 provider organizations nationwide. Contact us today to learn more about how we will help you speed up your hospital revenue recovery.
