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Revenue Cycle Leader Insights Series: Trends from Patient Financial Services

Patient Financial Services teams have had to adapt to a changing environment as a result of COVID-19. One session at our 2020 Virtual Health Finance Symposium focused on strategies for denials prevention and recovery, improving upfront processes and maximizing government reimbursements.  

Our discussion — Revenue Cycle Trends and Strategies Driven By COVID-19 — featured the following healthcare leaders:

  • Brad Tinnermon, Vice President, Revenue Cycle Management & Revenue Integrity at Banner Health (Moderator)

  • Rick Lyman, Senior Vice President, Enterprise Revenue Cycle Management, Memorial Hermann Health System

  • James McCurley, Vice President of Revenue Cycle at Community Medical Centers

  • Dorothy Rubio, Senior Vice President, Patient Financial Services at Envision Healthcare

The top 10 learnings from this conversation include:

  1. Denials and underpayments are complicated issues best solved by multidisciplinary teams. Be sure each team meets frequently to analyze data and puts action plans for specific areas in place.
  2. Don’t expect denial volume downturn to last. In fact, panelists indicated little change has been seen in the amount of denials due to COVID-19.

  3. Denials analytics can identify trends, but leadership needs to put them into action. One panelist discussed a collaborative approach involving a multidisciplinary team to regularly review denials and identify trends. From there, they choose a few to dig into further and review, analyze, track and measure over time.

  4. While it may seem like a good idea, giving payers real-time access to medical records can be tricky. To avoid potential errors or challenges, work with managed care to determine the proper access for future contracts.

  5. Payer scorecards can show directionality, but they don’t provide the detailed analytics needed to prevent underpayments and denials.

  6. Expect an influx of soft denials due to operations groups first working COVID-19-related accounts, without bringing in revenue cycle, utilization review and registration teams.

  7. Medicaid and Medicare Advantage plans are inherently complex, and the denial rates associated with each tend to be high. To avoid skewing your overall denial rate, it may be worthwhile to pull these out from your overall percentage.

  8. Keep your payer contracts up-to-date and fine-tuned to better prevent underpayments and improve collection efforts. It’s important to analyze the cost benefit of having your staff manage accounts versus utilizing an outside vendor.

  9. Robotic Process Automation (RPA) can free up staff time by eliminating some repetitive manual processes. However, denials management requires expert staff or a more sophisticated AI to dig into the analytics.

  10. The pandemic has impacted patient payments. There’s been an increase in patient responsibility after insurance and a heightened challenge to determine a patient’s propensity to pay. In addition, panelists have also seen expanded use of flexible, patient-friendly payment plans.

To listen to the full patient access discussion and much more, visit our Virtual Health Finance Symposium web page.


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