Take Off the Blindfolds… Start Aligning your Hospital and Physician Bills

You’re pursuing a corporate strategy that hinges on aligning your hospitals and physicians, you now employ hundreds of physicians, you’ve spent untold sums of money to have a community EMR, and you’re consolidating your business office.  Yet… you still operate your physician billing and hospital billing teams as independent and separate functions even though they’re addressing the same patient population during the same episode of care, sharing a common patient health record.  As crazy as that seems, that’s the current paradigm for most every U.S. healthcare system.

With technology now enabling the level of physician/hospital collaboration to meet the rising tide of healthcare consumerism, patients and payers expect health systems to present clear, concise and correct patient billing statements.  The public now expects more from providers in terms of price transparency than we demand of ourselves in terms of shared accountability for generating clean, complete and aligned patient bills.  Insulating Physician Billing (PB) and Hospital Billing (HB) teams from one another is a high-stakes, double-blinded experiment costing your organization precious time and money while eroding your margins and consumer confidence.  Now is the time to remove the Chinese wall separating your siloed billing functions by cross-pollinating your PB and HB information to optimize revenues across your enterprise.

Today, approximately 40% of U.S. physicians are employed by hospital systems.  The rise in Accountable Care Organizations and new alternative payment methodologies placing provider organizations at-risk for the quality and financing of health care along with the economic challenges (ex. MACRA) of operating independent physician practices will push this figure over 50% with a projected 14% increase in physician employment between 2014 – 2024.  With the investments made in recruiting, acquiring, managing and providing the technology tools for employed physicians along with the downward economic pressures on reimbursement, health systems must start innovating new ways of realizing the projected financial synergies their integrated delivery systems were designed to yield.

Revenue Assurance is a business activity utilizing data and process improvement methods to reduce revenue leakage thereby increasing profits, revenues and cash flows.  Leakage comes in the form of missed, miscoded or misplaced charges that leach out of your revenue funnel. Missed charges, as the term implies, are the simple omissions when a charge didn’t make its way to the patient’s bill.  Miscoded charges result from the normal variation of professional judgement involved in medical coding while Misplaced charges come from the fragmentation of our revenue cycle when we “park” charges in the various work queues within EMR systems awaiting further validation that potentially delays or prevents cash flow due to timely filing limitations if left unattended.  In growing numbers, Miscoded charges also result from disharmony in the way PB and HB teams independently code for professional and technical services.

In the fall of 2016, AcuStream, Inc., the market leader in Healthcare Revenue Assurance developed the industry’s first set of predictive business rules to detect misaligned PB and HB charges giving healthcare providers a next generation innovative solution to this problem.  Using similar algorithmic logic to that used by payers when reviewing/denying payment claims, AcuStream’s proprietary rules logic has produced the following results.  On average, rules leveraging the HB/PB matching logic produced >30% of the total Revenue Assurance predictions ranging anywhere from 15% – 80% of the total predictions for individual clients performing Revenue Assurance activities across both their HB and PB organizations!   Depending on the size of your organization, HB/PB matching logic can add millions to your net income and basis points to your profit margin.

For organizations looking to attack leakage and combat margin erosion, Revenue Assurance represents the low-hanging fruit of revenue optimization and a quick, certain way to shore up your revenue integrity function in a matter of weeks.  It will also provide you the ability to share billing/coding information allowing your revenue teams to see each other’s work, share their insights, and improve billing accuracy.  It’s time to remove the blinders and see the new possibilities for aligning financially across your hospital and physician organizations.

About AcuStream

AcuStream is a Revenue Assurance specialty company dedicated to the healthcare industry. AcuStream provides automated charge capture auditing technology solutions, value-add professional coding expertise, and decision support tools to the country’s leading healthcare providers enabling our clients to find missed revenue around charges they didn’t know were missing. We are the only organization with proprietary algorithms and custom client specific rules, that can correlate both the hospital data and physician data. This in conjunction with our world class workflow, allows us to find and track missed, miscoded, and misplaced charges.

AcuStream identifies and quantifies missed reimbursable charges for both Physician Organizations and Health Systems. REVBUILDER™’s automated post-bill auditing solution identifies omitted charges while REVREVIEW™ auditors validate charges against your own EMR documentation and payer contracts to ensure you get paid for the services provided.

AcuStream has been privileged to work with one-third of the academic medical centers on the U.S. News and World Report “Honor Roll of Best Hospitals,” seven of the 50 largest integrated health systems, twenty percent of the 20 largest not-for-profit health systems, and 10 of the nation’s largest physician group practices providing immediate financial lift/profitability, management insights and process improvements surrounding Revenue Management.Acustream currently processes over 100,000 doctor’s data on a monthly basis, thanks to our client base of top hospitals and physician organizations in the US. The result of our solution is improved net profit, decreased revenue erosion, and a clear view into departmental efficiencies.

We help you identify the missing pieces to your revenue puzzle, BEFORE you even start to put the puzzle together.

The Five Things You Should Start and Stop Doing Now to Solve your Revenue Leakage Problem

Revenue leakage is a very real concern for Healthcare providers costing hospitals and physician organizations billions of dollars each year in squandered net patient revenues!  Left unchecked, your profit margins suffer a slow ‘death by a thousand paper cuts’ as your organization incurs the cost of patient care delivered without the offsetting reimbursement.

In today’s highly competitive yet uncertain healthcare landscape, margin compression is a threat to financial sustainability. And yet, providers are letting their hard-earned revenue slip through the cracks of their revenue funnel at alarming rates.  Detecting and patching those leaks can provide immediate financial relief and lead to long-term process improvements.   Here then are the five things every provider organization should start doing – as well as the five things they should stop doing – to optimize revenue and avert leakage.

Five things to STOP Doing:

To carve out the bandwidth needed to attack leakage, it’s just as important to define the things you’re going to stop doing to afford your Revenue team the time to tackle the items you want them to start doing.   Practicing the ‘discipline of removal’ reduces the amount of time people waste, and in effect, refocuses their efforts and energy on achieving revenue results.

  1. Stop ignoring the elephant in your Revenue Cycle Room

Optimizing revenue is a two-fold solution.  You need to mitigate the “friction” in your revenue cycle operations to optimize efficiency and you need to restore volume to your revenue funnel by addressing leakage.  To truly manage leakage, you need information and assigned accountability.  Don’t assume you have either.

  1. Stop assuming your EMR is the silver bullet for Revenue Management

EMRs are the source-of-truth but not the tool-of-choice for managing revenue.  Like all enterprise systems, EMRs are too unwieldy to provide end-users or Revenue Cycle leaders ready access to granular, actionable leakage analytics and EMR IT resource constraints are a bottleneck for custom reporting.  As such, provider organizations must look to niche vendor solutions that can play off the EMR data to provide value-add analytics without taxing your already limited IT resources.

  1. Stop thinking you can fix leakage by overemphasizing your CDM

CDM management and charge auditing are separate, interrelated work streams; not interdependencies!  If you ran a retail store where you had 3% inventory shrinkage, you wouldn’t assume you could solve for wastage or theft via a price adjustment. Even if you chose to raise your prices 3% to offset leakage (something not easily done in healthcare), you’d only be masking the underlying problems.   Stop treating mid-revenue cycle leakage as though it is a book-keeping issue, it’s a multi-faceted operational process problem.

  1. Stop thinking you have the scale to ‘do it yourself’

You don’t hire full-time nurses to accommodate peak census levels and you don’t set your floor stock supply inventory levels for maximum demand either so why would you add staff to your revenue integrity department to go after the small percentage of patient charges leaching out of your system?  Outsourcing Revenue Assurance activities to an experienced partner with the requisite core competencies, cloud-based technologies and the ability to focus on a singular objective with greater economies of scale is the only cost-justifiable way to treat leakage.

  1. Stop looking at leakage auditing as purely a pre-bill function

HFMA’s Patient Friendly Billing guidelines call for providers to deliver clear, concise and correct billing information yet we rush to get out initial statements with 10 – 13% error rates by cramming an overwhelming amount of frenetic activity for revenue teams into the first 3-5 days post discharge.  Best practices call for identifying revenue leakage both pre- and post-bill to optimize charge capture.  Putting all your charge auditing eggs in one pre-bill basket at a time when you know your team is distracted and under pressure exposes you to significant financial risk.

Five thinks to START Doing:

Once you’ve freed your organizational mindset from these outdated ideologies, it’s time to champion the cause for revenue integrity!

  1. Start getting serious by attacking the problem

HFMA estimates 3 – 5% of charges never get posted which means the industry’s revenue defect rate is 10,000 times greater than a Six Sigma level of performance!  Active vs. passive leakage management is a worthy investment with a seven-figure net income impact and double-digit returns on your investment.  Don’t be passive, get focused by assigning a business owner, establishing goals and monitoring progress.  Leakage won’t solve itself; it requires leadership, structure and proper tooling to make it happen.

  1. Start aligning your Physician and Hospital Billing functions

Your corporate strategy is to align your hospitals and physicians, you’ve spent untold sums of money to have a community EMR, and you’re consolidating your business office but yet you still operate your physician billing and hospital billing teams as independent and separate functions even though they’re addressing the same episode of patient care.  Now is the time to remove the Chinese wall and break down these silos by sharing billing information.  A Revenue Assurance Program that cross-pollinates PB and HB information presents an innovative opportunity for revenue enhancement across your enterprise.

  1. Start taking the emotion (and defensiveness) out of the equation

Tracing the root causes of revenue leakage should not be a rascal hunt.  More often, leakage results from systemic process problems, obsolete business policies and/or technology gaps than human error.  Treat the management of revenue leakage as a data-driven/fact-based opportunity to learn and develop your staff.  Consider gamification strategies to encourage proactive employee engagement.

  1. Start approaching revenue assurance activities as an investment, not a cost

Recouping incremental revenue for the patient care you’ve already delivered converts directly into net income.  In fact, accretive revenue is more valuable than an equal % of variable expense reduction and can stave off the need for emergent spending cutbacks.  The operating margins on a Revenue Assurance Program are considerably higher and more predictable (shorter time-to-value, too) than front- and back-end revenue cycle management initiatives so it’s a smart and safe investment.

  1. Start looking for a partner vs a vendor

Charge capture auditing tools (i.e., technology solutions) alone can create mayhem for coding teams.  In isolation, automated predictions are prone to generating 50% or more “false positives” that erode the confidence and productivity of coders, who, in effect, are tasked to find needles in the haystack.  A value-add outsourced service that cleanses the predictions before they’re presented to your revenue team transforms the technology tool into a true solution.  If your charge capture vendor is heaping more complexity than value on your haystacks, offering only theoretic predictions vs. reconciling actual revenue recovery to the penny, and is charging you a flat subscription fee that has diminishing returns as you solve your leakage problems, it’s time to reassess the financial and productivity impact of that relationship and evaluate other options.

 About AcuStream

AcuStream is a Revenue Assurance specialty company dedicated to the healthcare industry. AcuStream provides automated charge capture auditing technology solutions, value-add professional coding expertise, and decision support tools to the country’s leading healthcare providers enabling our clients to find missed revenue around charges they didn’t know were missing. We are the only organization with proprietary algorithms and custom client specific rules, that can correlate both the hospital data and physician data. This in conjunction with our world class workflow, allows us to find and track missed, miscoded, and misplaced charges.

AcuStream identifies and quantifies missed reimbursable charges for both Physician Organizations and Health Systems. REVBUILDER™’s automated post-bill auditing solution identifies omitted charges while REVREVIEW™ auditors validate charges against your own EMR documentation and payer contracts to ensure you get paid for the services provided.

AcuStream has been privileged to work with one-third of the academic medical centers on the U.S. News and World Report “Honor Roll of Best Hospitals,” seven of the 50 largest integrated health systems, twenty percent of the 20 largest not-for-profit health systems, and 10 of the nation’s largest physician group practices providing immediate financial lift/profitability, management insights and process improvements surrounding Revenue Management.Acustream currently processes over 100,000 doctor’s data on a monthly basis, thanks to our client base of top hospitals and physician organizations in the US. The result of our solution is improved net profit, decreased revenue erosion, and a clear view into departmental efficiencies.

We help you identify the missing pieces to your revenue puzzle, BEFORE you even start to put the puzzle together.

The Elephant in Your RCM Room

Shhhhhh….There are things we just don’t talk about when it comes to Revenue Cycle Management.  It’s ok to talk about collection rates, days in AR, aged balances and denial rates because we’re all on the same page here in terms of performance benchmarks and the process improvement activities we’re undertaking to address performance.  But what we don’t talk about… the proverbial elephant in the room… is revenue leakage, i.e., charges that were never captured or got lost along the way and therefore never get billed.

If we visualize the Mid Revenue Cycle simplistically as a funnel with patients entering the revenue cycle at the top of the funnel, care being delivered, documented and coded with revenues exiting the bottom, the goal for Revenue Integrity professionals would be to get as close to 100% of the revenue their organization is entitled to receive in the shortest time possible.  In physics, this is referred to as the volumetric flow rate which follows the basic formula Output = Volume/Time.  If your goal is to optimize mid-cycle revenue, you then have two levers to pull…

  1. Make the flow “frictionless” by re-engineering and streamlining processes, AND
  2. Add more volume by eliminating waste in the form of Mid Revenue Cycle leakage (i.e., missed, miscoded or misplaced patient charges that leach out of the funnel).

I’ve emphasized the word “AND” because both volume and efficiency are critical factors in optimizing revenue.  Today, very few healthcare organizations are addressing the volume issue for two primary reasons…

  1. They lack the tools or analytics to measure and monitor leakage
  2. They view leakage to be a performance deficiency instead of an opportunity.

The reality is that leakage occurs in every hospital or physician practice – HFMA has estimated that 3-5% of all charges never get posted – and very little of it is related to human error.  Leakage often results from technology gaps, ill-advised or obsolete billing practices, or upstream process problems that are systematically causing leakage that can easily be re-engineered once the problem is identified, quantified, and analyzed for root causes.

This is why Revenue Assurance Programs are growing in importance.  Whereas revenue cycle management (RCM) solutions focus on streamlining operational processes surrounding known charges, revenue assurance concentrates on the identification of omitted charges that never make their way into your revenue cycle queue or have leached out of your revenue funnel. There are very few companies that focus exclusively on revenue assurance. An even smaller number combine a technology solution with a service component that intervenes to reduce false positive findings while also providing analysis that creates a dialog about codifying best practices. Applying rules-based and predictive analytics to the complex world of medical coding and billing simplifies and automates the labor-intensive process of manual chart reviews. It also yields consistently objective findings to break down silos in healthcare organizations by comparing data from different departments to ensure consistency and identify communication breakdowns.

 “Smart Investment”

Healthcare provider organizations have been compelled in recent years to make “strategic investments” in projects that have strategic importance regardless of the cost or required effort with no direct ROI often because there is an inherent risk if you don’t do it.  Enterprise Resource Planning (ERP) and Electronic Medical Record systems (EMR) fit that description.  And then there are opportunities to place bets on investments big or small because they’re the smart thing to do financially – what we term “value investments”.  We now use Bubble Charts to analyze the various projects in a portfolio to visualize the balance between the value or profitability vs. the size of the required investment vs. the perceived risks involved… namely, how likely is it that we’ll achieve the expected returns, what are the risks of a runaway project that turns out costing 2 – 3 x what we budgeted, and what is the timeline of the project and when do we expect to recognize a return on our upfront investments.

Initiating a Revenue Assurance Program is one of those Smart “Value” investments because of the low barriers to entry, short time-to-value (as little as 60 days), high probability for success and significant financial returns with extremely low operating costs.  The best part of the decision, is that you can now address the elephant in the room and begin measuring and managing your revenue leakage.

About AcuStream

AcuStream is a Revenue Assurance specialty company dedicated to the healthcare industry. AcuStream provides automated charge capture auditing technology solutions, value-add professional coding expertise, and decision support tools to the country’s leading healthcare providers enabling our clients to find missed revenue around charges they didn’t know were missing. We are the only organization with proprietary algorithms and custom client specific rules, that can correlate both the hospital data and physician data. This in conjunction with our world class workflow, allows us to find and track missed, miscoded, and misplaced charges.

AcuStream identifies and quantifies missed reimbursable charges for both Physician Organizations and Health Systems. REVBUILDER™’s automated post-bill auditing solution identifies omitted charges while REVREVIEW™ auditors validate charges against your own EMR documentation and payer contracts to ensure you get paid for the services provided.

AcuStream has been privileged to work with one-third of the academic medical centers on the U.S. News and World Report “Honor Roll of Best Hospitals,” seven of the 50 largest integrated health systems, twenty percent of the 20 largest not-for-profit health systems, and 10 of the nation’s largest physician group practices providing immediate financial lift/profitability, management insights and process improvements surrounding Revenue Management.Acustream currently processes over 100,000 doctor’s data on a monthly basis, thanks to our client base of top hospitals and physician organizations in the US. The result of our solution is improved net profit, decreased revenue erosion, and a clear view into departmental efficiencies.

We help you identify the missing pieces to your revenue puzzle, BEFORE you even start to put the puzzle together.