The COVID-19 pandemic has proven that fast, meaningful change is both possible and necessary for healthcare revenue cycles to keep up with a changing world.
But to make truly meaningful change within the revenue cycle, the industry will need to embrace even more changes, such as payer partnerships, greater automation, and standardization across payers.
Payer-provider partnerships could be as basic as providing additional education about patient benefits.
“I would like to partner with the payers to provide additional education to the patients around their benefits, what is or is not covered, what requires pre-certification, and what the patient’s expected costs would be,” says Jeannette Wood, vice president of revenue cycle management and credentialing at Privia Health in Arlington, Virginia.
She continues, “I would like to see payers, especially from a commercial side, really develop something that’s patient-friendly and at a level that’s understandable, similar to what is available from CMS.”
Payer partnerships could also be more complex, such as working together to get more claims paid.
“I would like to partner with the payers regarding the denials and the audits that they perform. I would be willing to take a little bit less on the rates if payers would commit to not denying our claims,” says Denise Szalko, vice president of revenue cycle at Rush University Medical Center in Chicago.
Automation is another area that can be significantly ramped up from how it’s currently utilized.
“Things such as claims, follow-up, anything that is normal routine business, are areas where significant automation is possible,” says Jana Danielson, revenue cycle executive director at Nebraska Medicine in Omaha. “In those scenarios, the only things you touch are the exceptions.”
She adds that she’d “really like to get to auto adjudication” and even greater automation for inpatient coding.
However, a major barrier to achieving automation’s full potential remains: A lack of standardization across payers and contracts. Danielson calls standardization “the very foundation to make sure that you can just go back and forth in an automated way without having several tweaks or creating rules that are just a little bit different for everybody.”
Szalko agrees, pointing to lack of standardization around the services that require preauthorization. For example, she says Chicago has a high number of labor funds and self-funded plans.
“Some of these employers place even greater burden on what needs to be preauthorized than, say, what a fully insured employer group may have,” she says. “If there could be some standardization around that, I think it would help with the ability to automate some of the processes even further.”
For More Information: https://www.healthleadersmedia.com/revenue-cycle/3-elements-needed-revenue-cycle-future