RCM: Unifying Business and Clinical Side of Healthcare

The rapid shift to value-based care continues to revamp the healthcare sector, bringing with it changes and challenges to the billing, reimbursement, and revenue cycle. This shift is coupled with increased expectations from patients for their healthcare providers, whether in services provided or making the payment experience more seamless and patient-friendly.

At Parkland, the first approach that we follow is to partner with a company or an individual who understands our business - from knowing who we are, our mission, and what we are trying to accomplish to providing products that will allow us to improve our operation concerning the given set of different parameters we operate in. Generally, companies approach us with a cookie-cutter solution, which, in their opinion, works across any market place. In some cases, companies offering a cutting-edge solution approach us, and at the same time, take into consideration the organization’s services to patients and model in terms of our funding.

One technology that is gaining immense popularity in hospital revenue cycle management is AI or Artificial Intelligence. Viewed from a functional standpoint, AI has a lot of potential in better management and client services. AI may have its highs, but considering the academic teaching environment we operate in, we require human intervention, decision making, and analyzing as well. AI can emerge to be beneficial for some hospitals that provide acute care services, but in terms of academic teaching institutions, it is best to wait and see the results before adopting the technology.

Implementation of RCM Solutions

Leveraging the technology (we already have closer to 100 percent, or as close as we can get,) has been an integral part of my approach. We were one of the first to adopt the EPICEHR solution into our organization. Being such a rich application, other organizations that have EPIC take years and invest in resources to utilize its full functionality. For example, let’s assume the system we have is capable of doing x, y and z; rather than introducing another disparate system to do the same work, we verify that it is actually doing what it is capable of doing and working for us.

From a technological standpoint, we primarily focus on process improvement opportunities and automate our functions within the current capabilities. Organizations need to envelop a wide range of functional aspects of the revenue cycle, from patient access, to eligibility and building clean claims. We must strive to organize continuous training programs for staff to reduce errors and maintain the crucial performance that occurs across the division.

The two proposals that could turn out to be disrupters in the industry are a single-payer system and an increase in bundled payments methodologies. We have encountered some of these “alternative payment model” proposals in certain types of chronic diseases and if the model expands to even more types of diagnoses or services, that would probably be a contributing disrupter.

Leadership Principals

I believe we have to empower people to think outside the box, make critical decisions, and to question and improve existing processes. From a personal standpoint, surrounding yourself and your management team with people who believe in improvement and have excellent decision-making skills is essential. A single individual alone cannot do everything that needs to be done; our job is to hire managers and directors, allowing them to lead with some of our input and to ensure the seamless functioning of the company.

Piece of Advice

In the healthcare business, one has to learn the clinical side of the company. From the moment a patient walks in until the time they leave, the whole process impacts the revenue cycle of an organization. Knowing the clinical team and staying abreast with the actual flow of work from start to finish is vital to be an effective leader in this business.