An expert’s opinion on optimizing the revenue cycle of health systems

An expert’s opinion on optimizing the revenue cycle of health systems

Revenue cycle, patient misidentification, patient safety- these are all the buzzwords that have been present in the healthcare scenario recently. However, the focus will be on revenue cycle since that is the specialty of Ms. Tina R. Strawn, who has an immaculate experience of 27 years and is currently serving Harris Health System as a Registered Nurse as well as the Administrative Director of Operations for Patient Financial Services. As evident from her years of experience, her area of expertise includes but is not limited to patient financial services, contract management, denial management as well as nurse auditing. 

According to Ms. Strawn, one of her proudest moments was the record achievement of clean paid claims, which is 84.5% to be precise, and it secured them on the top 5th percentile of Epic nationwide, the famous EHR system. For clarification, clean paid claims percentage refers to the rate of resolved claims that were either clean or never had any claim edits, denials or underpayment whatsoever. However, Ms. Strawn and her team did not manage this remarkable feat so quickly- they had to work tirelessly. A significant portion of time, effort, and resources were invested in the analysis of the claims- be it an edit, rejection, or denial. This was done in order to detect, rectify, and minimize any issues which caused these claims to be denied or delayed. 

One of the most prominent challenges Ms. Strawn faces in the field of the revenue cycle is the erratic claims and processing system of payers. These systems cause a lot of issues that generate either underpayments or overpayments. The biggest problem it causes is an unclear language that confuses both payers and providers and thus causes misinterpretation of the contract. Sadly the gap of time between payers agreeing to their payment systems having issues and fixing them is quite significant, thus, causing delays in the whole process. Such issues could have been avoided had there been some effective patient identification platform in place, but more on that later.

When asked what can be done to enhance the patient financial experience, Ms. Strawn replied that a tool that would aid patients with clarification of their financial responsibilities comparing it to the amount they have already paid would be extremely beneficial. Patients are entirely dependent on their payers for appropriate payments of claims, and they generally trust their payers to do so. Moreover, the patients are also willing to undertake the patient financial responsibility 

While asked what can be done to improve the revenue cycle, Ms. Strawn said that automation is the best strategy- if possible, do it. She further explains that it is quite tedious to adjust cases. Still, if this process can be somewhat automated or somehow reduced with the help of some form of technology, it would be extremely beneficial as it will reduce the workload, and the staff can instead focus on something much more crucial than just counting numbers and solving cases. 

Fortunately, there is already something in place for that. A lot of health systems are using RightPatienta biometric patient identification platform. You may ask, how can a patient identification platform help with revenue cycle? Well, RightPatient locks the patient record with his/her biometric data, thus, eliminating the chance of denied claims entirely. If the patient is not present within the health system, his/her biometrics cannot be verified. Thus, no unwanted healthcare service will be billed to the patient’s payer. Ultimately, the chance for denied claims reduces significantly as the patient is identified correctly every time. Health systems like Novant Health and Terrebonne General Medical Center are using RightPatient for accurate patient identification, which also helps them with revenue cycle optimization as well as reducing denied claims. 

Author Bio

Dan Raywood is the contributing editor of technologyness. He has written about IT security since 2008, having spent five years as a news editor of decisionmakershub

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