Article

Henry David Thoreau once said, “For every thousand hacking at the leaves of evil there is one striking at the root.”

A typical healthcare organization’s technology is largely a patchwork of providers (vendors) each with a system(s) responsible for communicating to the core system and none of the bolt-on systems communicating with each other. It is not an uncommon circumstance where a healthcare organization might buy or license at least 35 different products and services—just to manage the revenue cycle. A case could be made that switching in and out of bolt-on systems to gain some additional functionality or reduce a cost is nothing more than “hacking at the leaves.”

“Striking at the root,” of course, is to replace all the disparate and disconnected systems into a single role-based application that streamlines the collections process. The primary goal of healthcare revenue cycle is to create a complete, accurate, compliant and profitable bill(s) (“a clean claim”) correctly calculated and formatted for services rendered and ensure its complete payment in a prompt and timely manner, all within focused patient satisfaction and compliant with government regulation. One of a healthcare organization’s most important Key Performance Indicators (KPIs) is its “clean-claim rate” and yet very few organizations have a complete and accurate measurement without substantial manual effort.

Revenue Integrity Forces (opposition) in the revenue cycle create four “Integrity Gaps™ (input ≠ output) that affect the financial outcome (profitability, cash flow). The degree to which an organization can influence the Universal Revenue Integrity Forces™ will determine their financial performance (profitability, cash flow)

A “clean claim” gets paid faster. As a result, it’s critical to gather information on the back-end of the revenue cycle to identify what needs to be fixed on the front-end in order to improve your “clean claim rate.” That is much easier with a fully integrated system.

This kind of new system should come with “starter-kits” which help find and eliminate black hole accounts and processes. It should include a workflow, dashboards, analytics & artificial intelligence engine as well as a productivity management tool that gives every level of the organization the key metrics, indicators, alerts and education needed to take appropriate action to permanently resolve problems. It transforms your data into actionable information in real time; it forever changes how revenue cycle administers see their business. It should include functions similar to an iPad – each report, dashboard or analytic is a self-contained mini-app that is created without programmers. These apps are available in an app library for all users to access and share both internally and externally with other organizations. These apps would help report “best practice” across organizations.

It should also include workflow tools which not only allow you to automatically route account responsibility from one individual to another or to an outsourced claims management vendor, but allows you to quickly tailor (customize) services (i.e., what constitutes a denial, contract management terms, alert notifications, upfront registration rules checking, etc.) based upon your organization’s needs, without changing source code and without any programmer involvement.

This sophisticated system should make it easy to manage your outsourced claims or other work within the revenue cycle; helping you to ensure accountability, honesty, and results driven partnerships with your vendors. If you choose to outsource work to vendors you should not have to learn a system, new reporting tools or even a new language. You should not have to rely upon your vendor to provide you with direction on how they will communicate to you and what their rules of accountability are. You should have the benefit to work seamlessly in this new system with your vendors, therefore making it easy in keeping them accountable, on task and driving results according to the goals, principles and processes of the hospital, not their own bureaucratic organizations that are focused on doing what is easiest and cheapest for them.

This system should use a sophisticated database management system which allows end-users to see the status of the receivables for any day or date range. It should not be limited to the typical month-end reporting. We might think of it as a “time machine.” Although a practical reason to expand the reporting to include hour, minute, and/or second (even millisecond) of any day has yet to be identified, the architecture should be able to handle it. Maybe you want to see how the number of assigned accounts for a particular collector changed from July 17th to Sep 24th. No problem. Maybe you want to see the total number of accounts and current balance as they existed on May 13th. Certainly! Maybe you want to see the status and notes for a specific account as they existed none months ago on February 4th. Absolutely!

This very sophisticated, next generation revenue cycle software tool should proactively prompt collection’s personnel where to focus their time and talents and provides definable alerts to supervisors. The tool includes mentoring software that focuses on results, guides collectors through payment strategies, trains new employees and it keeps your claims management vendors accountable and on task. It’s like having an experienced adviser at the collector’s side 24/7.

Integrating your physician’s revenue cycle into a seamless platform with the hospital should not be difficult or require another disparate system. This new system should be able to normalize data, workflow, reporting, communication and process improvement between the hospital and its physicians (even if they are not completely affiliated). No administrator should have to go into more than one system to see how their enterprise/organization is performing, neither should they need to rely upon more than one system for all of their reporting needs. This system should be able to provide the board of directors and administrators with the same reports/information in “Real Time, Any Time™” that is accurate and reliable.

So what benefits would this kind of ideal solution provide? Some benefits should include:

Change your perspective about your revenue cycle; where & how you focus on it, and the kind of results you see.
Change your strategy of how you deal with payers.
Change your people’s understanding of their stewardship and how they carry it out.
Change how you and your people communicate.
Change your relationship with and within the larger healthcare community.
Change how you think about revenue generation and how you maximize it.
Change the kind of support you get with today’s healthcare technology.
Seamless Integration with vendors, physicians, or corporate partners.
Effortless data acquisition and analysis for mergers, acquisitions and buy-outs.
Consistent, accurate and “Real Time, Any Time™”.

The good news is that the system described above is not some pipe-dream. It exists now! It’s a system from Obsidian, Inc., which offers a complete, fully integrated, single source system to the healthcare revenue cycle industry. So the question is, “Do you like ‘hacking at the leaves’ or would you like to begin ‘striking at the root.’”

Leaves and Roots