Rev­enue-cy­cle firms tackle value-based pay­ment and ICD-10

Modern Healthcare - - CLASSIFIED MARKETPLACE - By Michael San­dler

Rev­enue-cy­cle man­age­ment firms are evolv­ing along with their healthcare provider clients as pay­ment shifts from vol­ume to value, ex­perts say.

Providers have be­come adept at nav­i­gat­ing end-to-end rev­enue col­lec­tion, said Court­ney Thayer, a prin­ci­pal with Deloitte Con­sult­ing. What they now need from rev­enue­cy­cle firms is a broader range of sup­port ser­vices, par­tic­u­larly in max­i­miz­ing rev­enue un­der new value-based pay­ment mod­els, she said. That re­quires rev­enue-cy­cle firms to of­fer clin­i­cal ex­per­tise to help clients meet cost and qual­ity tar­gets, Thayer added.

There’s also a shift in how clients are pay­ing rev­enue-cy­cle firms. Pay­ment is be­com­ing more de­pen­dent on providers’ pa­tient-sat­is­fac­tion grades. Billing and col­lec­tion prac­tices can drive big swings on those mea­sures, so firms must de­velop a strong un­der­stand­ing of cus­tomer en­gage­ment, Thayer said.

Even though the healthcare ecosys­tem has changed, “rev­enue cy­cle is still the life­line,” she said.

Another is­sue bear­ing down on rev­enue-cy­cle firms and the providers they serve is the fed­er­ally man­dated Oct. 1 dead­line for con­ver­sion to the ICD-10 cod­ing sys­tem. Rev­enue-cy­cle firms are in­tensely pre­par­ing.

AGS Health in New York has been train­ing em­ploy­ees on the cod­ing sys­tem so that bills are sent to in­sur­ers on time and in proper form, said Deven­dra Sa­haria, CEO at AGS. The con­ver­sion is caus­ing providers anx­i­ety be­cause they worry cash flow could be af­fected if bills are sent out in the wrong for­mat, he said. AGS has in­creased staffing for its cod­ing busi­ness by 30%, hir­ing 300 coders in the past three months.

But even as providers and rev­enue­cy­cle firms en­ter new fron­tiers, they must re­mem­ber to be sen­si­tive to pa­tients’ billing con­cerns, Sa­haria said.

Pa­tients may want to pay but can’t af­ford to, he ex­plained. Mis­han­dling pa­tients or not pro­vid­ing them enough in­for­ma­tion may anger them to the point that they seek care from a dif­fer­ent provider.

If pa­tients are un­able to pay, it’s im­por­tant to work with them on a pay­ment strat­egy and help them learn the process, Sa­haria said.

“Peo­ple are busy with their lives, and when they get sick they don’t have time to in­ves­ti­gate ev­ery­thing,” he added.

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