20 insights from 10 healthcare revenue cycle leaders
The 2024 Kodiak Healthcare Virtual Symposium featured useful insights on automation, claim denials, payor behaviors, and revenue cycle’s future.
Kodiak Solutions healthcare events are unique among healthcare finance events because they showcase the revenue cycle leaders who are willing to share their first-hand experiences and practical advice with their peers across the country.
The 2024 Kodiak Healthcare Virtual Symposium, held March 13, 2024, featured 10 such leaders who candidly provided their thoughts and insights on four of the hottest healthcare revenue cycle topics today: automation, claim denials, payor behaviors, and the future of the healthcare revenue cycle.
On Automation
“We are in an environment where the expectation from the payors, the expectation from our customers, is an expectation of near perfection. We are expected to do so many tasks on the front end and get them right every time. To dot every ‘i,’ to cross every ‘t.’ It is so hard. It is a hard job. Automation is going to be a key as the demands evolve, as we have to do more and more tasks in the future, as we have to get so many things right.”
– Charles Colvin, System Vice President, Revenue Strategy, Baptist Health
“The key would be to simplify coding processes and automate as much as we possibly can and have more exception processing for all aspects of coding. Some of our coding today is exception processing, but some of the more complex coding is not. In order to achieve the cost reductions we need and be able to keep up with the market from a labor perspective – coders are hard to find – it’s in our best interest to really pursue automation.”
– Mark Norby, Senior Vice President, Revenue Cycle, University of Maryland Medical System
“Denial management will evolve in a couple ways. When we look at where it is right now, we've got a lot of new shiny toys. We all have AI (artificial intelligence) automation, machine learning, we're all unleashing it. We have insurers using AI to review itemized statements and UBs (unified billing forms). They're denying claims. We're now using AI and bots to automatically send the information that's requested. So right now, we've got bots on one side, bots on the other, and they're appealing and denying each other. It's a bit of a bot war. We've got to figure out how to automate that in a way that's a little bit more constructive. What's so critical is not just automate a bad process but figure out how do we improve the process and use automation to help facilitate accelerate some of the issues. Not just to automate a bad process just because we can.”
– Jennifer Igel, Chief, Insight and Performance Management, Providence Health
“When we talk about automation, we also need to talk about interoperability with the payors because why can pharmacy do it and we can't in the hospital environment. Some of it has to do with efforts by the insurance companies to not want to do it. But I think interoperability is going to help us along the way.”
– Kim Hodgkinson, Hospital System CFO
“It has been a little bit of a shift from trying to automate the entire process to focusing and simplifying what are the pieces of the process that can be automated.”
– Gary Simkus, Vice President of Finance Analytics and Systems, Universal Health Services
On Claim Denials
“We tend to see sometimes lots of touches on an account in order to get it out the door for proper billing. So, we are working on an initiative right now to decrease the amount of manual touches of an account. Our CFO has used the term OHIO for Only Handle It Once.”
– Michelle Greame, Assistant Vice President for Revenue Integrity, Inova Health System
“We're much better in the concurrent review, pre-bill space. We're winning cases, making the appropriate status determinations. Then we have less that needs to go through that appeal process. The ones that go there are all strong cases. We win them. Our physician advisors are saying, ‘You know, even though I lost the peer-to-peer, we think this is a strong one and here's why.’ We've got strong physician and nursing input into that process. Once we get that denial that we expect, then we can work it more effectively.”
– Dennis Shirley, Vice President of Revenue Cycle, UnityPoint Health
“As regulatory changes happen every year, we discuss those in advance, and we talk about how we're going to interpret those and how we want to implement those changes.”
– Angie Wilson Reis, Director of Utilization Management, UnityPoint Health
“Initial denials have really drowned everyone. We need to work these and get them out of the door and turned around, and (working with an outside vendor) gives you the time to breathe and figure out what you can do differently or better. What can we automate? What can we do to prevent them? How can we partner with our payors to have a different way for them to access the information? Having a vendor out there who's ready to come in at the drop of a hat, who knows you, how you work, is so valuable to have.”
– Jennifer Igel, Chief, Insight and Performance Management, Providence Health
“We traditionally have what we call the ‘hot hand.’ We usually have a vendor that we have aligned with that has end-to-end services that we can reach out to should we need any of those services. For instance, if we see a sudden uptick in denials. They understand our process, our organization, and what we prefer from a relationship standpoint to do the work for us quickly rather than standing up a new or net new vendor for us.”
– Jacob (Jake) Collins, Associate CFO, Revenue Cycle, Denver Health
On Payor Behaviors
“We’re turning internally to figure out ways we could build strategic partnerships between revenue cycle, managed care, and finance to drive that speed-to-insight to respond to the changing payor behaviors. It’s becoming more important to provide leaders with the right information at the right time to make those key decisions on whether you stay in network with certain payors.”
– Gary Simkus, Vice President of Finance Analytics and Systems, Universal Health Services
“As our margins have become tighter, as payors are increasingly focused on maximizing their margins, including retaining funds as long as possible, maximizing interest opportunities, collecting becomes an ever-bigger challenge. We have to be able to identify discrepancies in payments. We have to be able to effectively pursue those discrepancies effectively, appeal denials. The volume is overwhelming. It is probably going to become more so in the future. Automation and artificial intelligence are going to be pivotal to surviving that change.”
– Charles Colvin, System Vice President, Revenue Strategy, Baptist Health
“One of the key things is really population health and value-based contracting. The traditional managed care negotiator is in a tough spot now where he or she traditionally handled fee-for-service agreements. That was a skill set and way of thinking about things. Now value-based contracting and the population health metrics that come with that are hitting that traditional managed care person hard. A lot of people are feeling somewhat overwhelmed. We need more help. I do see having more resources – particularly in the analytics function – dedicated to the managed care and the revenue cycle space.”
– Paul Spencer, Vice President, Managed Care and Revenue Cycle, Froedtert Health
“We found that now that we have data, we can have real conversations. Before, we didn’t know if we're winning or if we're losing. We didn’t know if the anecdotal payor behavior is actually what we think. We’ve seen a lot of benefit because now that we know, we can communicate the good, the bad, the ugly. We’ve got our attention on the right things.”
– Dennis Shirley, Vice President of Revenue Cycle, UnityPoint Health
“The biggest thing is to keep the communication open with the payors and sharing your data versus their data and reconciling that. What payors don't realize is, if I'm getting paid $100 but have to write off $20 because of unpaid self-pay balances, I'm really getting $80. Communicating with them about what those rates really mean, what reimbursement means, and being transparent about what our data says versus what their data says is critically important.”
– Kim Hodgkinson, Hospital System CFO
On the Future of Revenue Cycle
“Managed care and revenue cycle are going to continue to integrate more and more over the next several years. The place where managed care and revenue cycle really integrate and meet is revenue integrity. The role is going to continue to increase in importance in every health system over the next several years. You're going to see a blurring between what managed care people are doing and what traditional revenue cycle people have been doing. Everyone's going to be really focused on this idea of capturing every dollar that the health system can. You’re seeing the new title of chief revenue officer pop up in health systems that roll up managed care and revenue cycle into one. That’s something that you’ll see more often.”
– Paul Spencer, Vice President, Managed Care and Revenue Cycle, Froedtert Health
“What's going to transform revenue cycle over the next five years in patient access is really setting up what's called a contact center. That would be a center that would be akin to your customer service center today, your scheduling center, or scheduling operations. The concept of the contact center is to give more than just the option of a telephone call.”
– Mark Norby, Senior Vice President, Revenue Cycle, University of Maryland Medical System
“We have focused on bridging the gap between managed care and revenue cycle and fostering that relationship because there's a lot of knowledge-sharing opportunity. Revenue integrity helps lead those monthly discussions where we look at any payor trend issues may need to get escalated to a JOC (joint operating committee). It's also an opportunity for revenue cycle to share with managed care any new service offerings that we're planning for new providers, and then for managed care to share with us any new contract updates. It's really worked well to break down the silos between those two areas.”
– Michelle Greame, Assistant Vice President for Revenue Integrity, Inova Health System
“Incorporating us (utilization management) in with revenue cycle was really the best decision we could have made. Same with the physician advisors. That has been key too, because they also did not always know what happened to that case in the end. Bringing us into that revenue cycle team has really let us see all of those pieces that were hidden.”
– Angie Wilson Reis, Director of Utilization Management, UnityPoint Health
“We see a lot of the point-specific vendor solutions, whether it's niche components, whether it's complex clinical denials, some DRG transfer work, some zero-balance and underpayment components, some of the things that we can’t necessarily do in-house. We need to leverage a lot of those components out. Our vendors are our partners to get the work done. It's imperative that we maintain the relationship not only for the organization but for the patients to make that all of the components flow through smoothly.”
– Jacob (Jake) Collins, Associate CFO, Revenue Cycle, Denver Health
Conclusion
For more insights and ideas that you can take back to your own hospital, health system, or medical practice, check out the 2024 Kodiak Healthcare Virtual Symposium event summary, which includes synopses of all sessions, additional insights, and links to on-demand recordings of each symposium session.