Trends and challenges surrounding revenue cycle in the health care industry today

Candice Hoshi, Vice President, Revenue Cycle, UCHealth

Candice Hoshi, Vice President, Revenue Cycle, UCHealth

Every healthy revenue cycle is trying to address the question: “How can I increase the value of delivering the same or better quality at a lower price?”Value loosely encompasses patient experience, performance excellence, and a motivated/engaged workforce.

Revenue cycles must directly contribute toward enhancing the patient experience if we want to remain competitive and successful. UCHealth’s online self-service estimator tool provides out-of-pocket expense estimates for services while connecting in real-time with patients’ insurance plan information. This year we’ve continued to invest time by adding guest shopper estimates. We’ll continue to innovate in this space beyond the federal mandates that affect all hospital providers on January 1, 2021.

Maximizing system automation within the patient billing system should always be a priority. One of the ways we’ve done that is in the registration space. We’ve spent a lot of time developing our system and using tools that allow the system to select the correct coverage based on a patient’s real-time eligibility response. Today, about half of all our coverage is added by the system. Not only does it directly contribute to lower denials and accelerated cash flow, but it also eliminates pressures on frontline staff and allows them to focus on delivering great patient care.

“There is a difference between disengaged and engaged leaders, but that difference can be a fine line at times.”

One of the bigger pain points in revenue cycle management is the lack of a robust self-service analytics tool. Every organization has an internal analytics support team or outsources to a third-party vendor but little is available directly to the frontline leader. We spent the past year formally rolling out Epic’s self-service revenue cycle reporting tool, and it’s been a game-changer. Removing the reliance on an analytics team not only improved end-user satisfaction but gave them the confidence boost and tools to perform well at their jobs. I’m particularly proud we were able to roll it out right before COVID-19 changed our lives.

There is a difference between disengaged and engaged leaders, but that difference can be a fine line at times. I try not to get too involved in individual department operations and believe in empowering leaders to develop the confidence and skills to be successful in their scope. At the same time, I try to stay engaged with what’s happening in Epic, connecting with industry colleagues, and always trying to think about how to improve upon prior years’ accomplishments. Investing in people and giving them the right tools and resources goes a long way in preserving performance excellence and maintaining that motivated workforce we all desire. I am also fortunate to have a dedicated Epic revenue cycle team. We train our technical teams to understand operations, and vice versa, which helps fuels this creative synergy.

Revenue cycle can succumb to hive-mind mentality: If you don’t go out there and seek information on what others are doing, you can easily get behind because it changes quickly. Staying rooted in others in the industry will allow you to feel confident in the decisions you’re making for your organization. Sometimes the most popular opinion isn’t right for an organization – you have to know what everyone else is doing before you can make those decisions for yourself. It’s dynamic, exciting, and we’re all constantly trying to set a higher bar for ourselves. We’re all fairly competitive but in a healthy way. I love the collaboration between health care systems and want to continue to see it as it improves all our organizations for the better.

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