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...
At Becker’s 7th Annual HIT RCM Conference in Chicago, FinThrive’s Chief Innovation Officer John Yount was joined by Brad Tinnermon, VP of Revenue Cycle and Revenue Integrity at Banner Health, and Matt Leary, VP of Finance at Centura Health. Read on to learn what they had to say about the three keys to modernizing healthcare revenue management for empowered providers, payers and patients.
Key #1
Identify Core Competencies
One of the primary ways you can increase efficiency and reduce friction at your organization is to assess your team’s core competencies, explained Brad Tinnermon. The Phoenix-based, 28-hospital system’s revenue jumped 18.9% from 2020 to 2021. Tinnermon, who spent 12 years working in managed services prior to joining Banner, understood the value of identifying topnotch outsourcing. “We’re not a tech shop,” he said. “We consider our core competencies and then outsource from there.”
After conducting an internal assessment to identify strengths and areas of opportunity, the Banner team concluded that analytics were strong, but automation was needed. This led to vetting and ultimately choosing a partner to implement an automation strategy that would work to reduce employee burnout and save Banner’s bottom line.
Today, Banner uses automation for a variety of revenue management processes, including intake, scoring hierarchy, governance, benefit measurement and monitoring. The success of these measures lies in the number of records touched, hours of work saved and so much more. Bottom line? Identify your core competencies and the data will tell you where to go.
Key #2
Foster Payer and Provider Collaboration
While payers and providers have historically had a tumultuous existence, it is possible to strengthen the relationship in ways that will lead to a better patient financial experience. One of the biggest ways is data.
“There is a lot of data to support whether a payer is treating us fairly or not,” said Tinnermon. “The area we struggle with the most is on the front end, which is arguably the most important part because it’s patient interaction.”
Thanks to technology, Banner has a joint tool with their payer to see into both systems and simplify processes that could otherwise be complicated. In addition, both Banner and their payer take advantage of a contract management system to streamline workflows. This helps to ensure that collections are made on time and revenue leakage is eliminated.
Centura Health has implemented a similar approach. “We gave some of the major payers access to our EHR , and for the first 60 to 90 days we were getting additional documentation requests,” said Matt Leary. “By granting payers visibility into what’s going on behind the curtain, we have been able to mitigate bottlenecks and avoid the cost of reworking denials.”
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“By granting payers visibility into what’s going on behind the curtain, we have been able to mitigate bottlenecks and avoid the cost of reworking denials.” |
Key #3:
Control the Controllables
There are many scenarios to consider when it comes to the success and struggle of your journey, and Centura Health was no stranger to this.
“We recently acquired two hospitals and are working on a handful of other acquisitions,” said Leary. The 17-hospital system based in Colorado announced earlier this year that they were bringing two LifePoint Health hospitals under their umbrella: Colorado Plains Medical Center in Fort Morgan and Western Plains Medical Center in Dodge City, Kansas.
Despite an aggressive acquisition strategy and all the corresponding changes, Centura has been able to fix costs for client services. “This has been a real value-add to our operations,” said Leary. “Unfortunately, minimizing inflation is more difficult, and something we cannot control. What we can control is how to collect every dollar possible.”
To that end, Leary and team have brought in the help of a consulting partner to reduce administrative burden and net collections faster. “Our partner helped us to see the value that can be achieved with an offshore opportunity, and we haven’t looked back.”
Moral of the story? Focus on the things you can control. Identify what issues are within your control and prioritize solving them.
Rethinking revenue management and implementing this new vision will empower providers, payers and patients, while advancing the healthcare economy. The future of revenue management can be frictionless, efficient and collaborative.
For information on an Autonomous Revenue Cycle, get our guide.
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