Top 5 Mistakes in Claims Management – And How to Avoid Them
Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause...
By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
Sweet home Chicago. I just got back from one of my favorite conferences – Becker’s Health IT + Digital Health + Revenue Cycle Annual Meeting. Becker’s has many flavors, but out of the dozens of other conferences I attend each year, the Becker's RCM conference is one of my top choices. It is my favorite for two reasons – one, nothing beats Chicago in the Fall, and two, the content is unsurpassed. It is an all-panel format, featuring some of our industries' biggest and brightest leaders. Key themes from this conference surrounded Artificial Intelligence, Payer Relations, and Digital Health. Let’s get into what I saw while there and some of the insights from the conference.
I’ve attended this conference since its inception, for eight years running. It continues to evolve and grow, which has its pros and cons. From a positive standpoint, the speakers, networking, and content have continually become more relevant and qualitative. Constructively, having these three behemoths, RCM, IT and Digital Health in the same conference can make it challenging to absorb everything the conference has to offer. In my opinion, we are at a point where all three of these facets are worthy of their own time.
As far as the conference goes, it kicked off with a keynote from CIOs from prominent orgs – Common Spirit, UPMC, UT Health and others. They spoke about the importance of truly understanding AI, balancing priorities, and leading beyond IT. They spoke of competing priorities for EMR-based tools, and how they (CIOs) have a tough job. The speakers concluded that technology should not “come from” IT – rather it should be supported by it. Tech needs to grow organically from a business problem – a bright shiny object should not be purchased for that; it should solve a problem for the organization and its patients.
FinThrive along with customers, Shanda Richards (CPGH) and Mike Vigo V (UCSD), hosted a session on a new model to assess the impact of technology on the revenue cycle. The Revenue Management Technology Adoption Model (RMTAM) was presented by Jeff Becker, VP of Portfolio Marketing, FinThrive. He outlined the tool’s progress, including the 100+ organizations that have utilized the new framework to assess current revenue cycle performance and help guide the right path for future tech investments, etc. The model evaluates on a two-fold approach – the value of RCM technology and its actual use (or prevalence) at organizations. This naturally places an organization taking an assessment on a spectrum of adoption, from zero to five.
Shanda and Mike provided specific insights on how the RMTAM framed their RCM strategies. Attendees were invited to take an assessment for their organization, and I encourage you to do the same with this link.
There were many sessions on AI. It was everywhere – and I get it – AI took a little while to get to healthcare and now everybody wants some. In some of the better sessions I saw, there were good presentations with solid application of AI technology in real world tasks – prioritizing and automating tasks, taking the mundane from “schedgistrars” (hybrid patient access roles) and allowing them time to focus on complex issues, and most importantly – the patient. There were other presentations that missed the mark. AI should stand for actionable information, instead of artificial intelligence. CIOs, RCM leaders and others all shared during Becker’s that if evaluating AI, ensure it is understood, deployable, scalable, and valuable. Solutions in the AI space should solve a specific issue and automate it.
Another theme from the conference surrounded a familiar favorite – payers. I have never, in my career, seen more friction between two entities. Providers and Payers are at odds with one another. Times ten. Between contracting, prior auth, medical necessity, denials, underpayments, failed meetings, renegotiations, and ultimately litigation, the gap has become wider. Changing provider manuals and claim edits have caused a firestorm for providers desperately trying to get paid for the services rendered. Payers are attempting to manage care as they were designed to do, and it is being met with much resistance. We as an industry will not solve this through disagreement.
Trust needs to be reestablished, and frankly, I feel it begins with the contract. Close examination by both parties should afford what is, and is not, out of bounds. For a provider, the provisions that are leveraged by the payer that afford the payer the right to do what they are doing should be agreed upon, removed, or changed for mutual agreement. Arguing claim by claim, denial by denial will not fix this long term. It must occur in the contract. Solutions that look at contract management, analyzing timing of payments and their shortfalls should be closely evaluated to succeed. Many of the presentations echoed this sentiment, but they were overshadowed by the immense frustration from the provider community over payer tactics. The industry must work together on mutual rules surrounding payment – or it will only get worse.
Another theme surrounded the importance of digital health. As we engage as consumers with all other industries digitally, it is time for healthcare to come to the plate. Several sessions discussed strategies with engagement with the patient as payer – they are consumers – shopping on convenience, cost, quality and others. Sessions spoke about engagement and loyalty, and most importantly the significance of the lifetime value of a patient – clinically and financially. Many sessions highlighted the need to connect with consumers on a digital level, and when they become patients, afford them a lifetime experience that delights them in getting their care at your organization.
The 8th Annual Health IT + Digital Health + Revenue Cycle Annual Meeting was the highlight of my fall. To find out more about the Revenue Management Technology Adoption Model or how your organization can join us to embrace disruption and challenge the status quo to improve your revenue management, visit us here.
If there is anything I can elaborate on, or you want to chat further, please reach out to me at jonathan.wiik@finthrive.com, or on social media. Be well.
About the Author
Jonathan G. Wiik, MSHA, MBA, CHFP
Vice President, Health Insights
Jonathan Wiik, VP of Health Insights at FinThrive, has over 25 years of healthcare experience in acute care, health IT and insurance settings. He started his career as a hospital transporter and served in clinical operations, patient access, billing, case management and many other roles at a large not-for-profit acute care hospital and prominent commercial payer before serving as Chief Revenue Officer. Wiik works closely with the market and hospitals on industry best practices for revenue management. He is considered an expert in the industry for healthcare finance, legislation, revenue management and strategic transformation.
