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● Cover Story: Revenue Cycle Management Roundup

How automation helps steer the revenue cycle process

While the goal of revenue cycle management remains essentially the same, healthcare reform will make it infi nitely more complex.

By Phil Colpas I

f there’s one aspect of healthcare that’s omnipresent – that is connected in some way to virtually every component of the medical trade – it’s the revenue cycle; and vendors’ solutions to manage it are as varied as the

experts we queried on this topic. The revenue cycle actually touches on nearly every-

thing related to healthcare – from the time a patient books an appointment with a healthcare facility, until the patient and insurance company provide final payments for services rendered to the healthcare provider. Over the past several decades, software programs and computers have replaced ledger books and calculators. And while the goal of revenue cycle management (RCM) remains essentially the same, healthcare reform will make this process infinitely more complex, due to reduced reimbursements and the onset of ICD-10 in October 2014. Additionally, reimbursement will be tied to qual- ity, rather than quantity. According to an Information Week article by Ken

Terry, outsourcing of billing and collections continues to grow, “because hospitals and physician groups are not

very good at these non-core tasks.” Think writers and math: I know a great many writers, including yours truly, who possess truly weak math skills. Granted, both skills involve opposite brain hemispheres – different parts of the brain. But what may be even more important is the fact that math is not generally an integral component of the main function of writing. A similar situation exists in healthcare facilities; just replace writing with providing care for people. A 2012 Black Book Rankings survey states 96 percent of organizations are in the process of acquiring several crucial accountable care organization (ACO) data solu- tions, including clinical decision support, RCM, health information exchange (HIEs), electronic health records (EHRs), e-prescribing, data center security and storage solutions, business intelligence and care coordination management. So it’s clear that RCM will continue to remain a top- of-mind issue as we see how healthcare reform plays out. Here’s what our select group of experts had to say about how automation helps to steer the revenue cycle process.

Edward Wrzesinski, Jr.,

CMPE, director, RCM services, Allscripts

RCM should be closely connected to patient data Revenue cycle is more closely linked to care quality than

ever before. As government and commercial accountable care organizations (ACOs) spread around the country, health insurers are continuing to look for more programs that peg physician and hospital payment to performance metrics. T at’s why RCM technology has to be just as closely linked to data in the patient chart. More importantly, organizations need

8 June 2013

the tools to analyze the data to fi nd out where costs are growing, where revenue is improving and how costly patient populations are responding to interventions. To prepare for the increased number of value-based payment models, here are some other factors to consider when assessing revenue cycle technology: • Flexibility: Health plan and government requirements for physician performance will continue to change in a value-based payment market. An organization’s RCM system needs to adapt by allowing for simple back-end confi guration as health plan contract terms change.

• Data accessibility: With the arrival of the ICD-10 deadline next year, payers will be armed with even more data to deny an organization’s claims or reduce payment. Be prepared


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