What's the fuss about? Revenue cycle management

Cash is no longer king, and the IT infrastructure to build the healthcare provider networks into one happy family, aka regional health information exchanges, will fall to the shoulders on the IT administrators and programmers.

"Write it down in dollars, and cash it" has turned into "collect it electronically and analyze what happened" in healthcare IT circles. Cash is no longer king, and the IT infrastructure to build the healthcare provider networks into one happy family, aka regional health information exchanges, will fall to the shoulders on the IT administrators and programmers. All this is under the heading of "revenue cycle management." For many years, paper was the answer to claims management for healthcare providers, but federal mandates created programmatic changes to the entire process of getting paid by payers, turning this into an electronic exchange of data. (Example: The final transition to the National Provider Identifier numbers, or NPIs, mandated by HIPAA Administrative Simplification Standards became all-inclusive and mandatory on May 23, 2007. The 10-position NPIs replaced the legacy provider identifiers that were once used by healthcare providers, clearinghouses, health plans, and many others for billing and claims identification.)

These early steps to the electronic medical record, formerly labeled claims management, now encompass much of the integration necessary for a healthcare institution down to a physician practice to be an accountable care organization, as well as a profitable organization.

Accountable care is still being defined in the federal circles where it matters most for even more mandates, but generally speaking, touching the entire lifecycle of the patient and making the payment system work so that the healthcare delivery mechanisms are responsible for proper care and profitability are at the heart of it.

This innovation of electronic claims processing has raised the benchmark on what can be done with this data to levels involving improved patient care, reduced costs, increased productivity, and increased reimbursements. Revenue cycle management can no longer be defined as just "claims management," but it has evolved to a bridge between clinical care issues and IT integration up to and sometimes including the electronic medical record. By tracking and being in dialogue with the payers involved, cash flows and allows for a stronger assessment of where the patient is at, recommendations for the patient, and the ability to get it done before the patient arrives for the treatment protocol.

So how can a physician practice or even a hospital figure out the best path in the revenue cycle management game? For a list, you can go to the Fierce Marketplace HealthTech that lists "2011 Top Revenue Cycle Management Companies" and begin to read their white papers. The promise of all the white papers is performance, profitability, and better patient care. But at the heart of the choice is always confusion until basic needs are sorted out at the healthcare IT level.

The best principles in revenue cycle management boil down to simple ideas, building on the flexibility for the patient and the payer to pay securely, including:

  • Improved cash flow
  • An expanded patient base
  • Better client retention rates
  • Higher sales revenues

The adoption of the electronic medical record is no doubt being spurred on by the executive of a $27-billion incentive program under the HITECH Act, and the shift is not going to stop. Evidence is mounting that revenue cycle management will soon include in all its discussions the leap to the electronic medical record. Louisville-based Zirmed, a revenue cycle management player, just announced another partnership on Feb. 3, 2011, with an EMR topping 2,000 clients, Altex Business Solutions, which will enhance the end-to-end payment management capabilities. The explanation goes like this, from Lee Orsag, Owner of Altex, "Altex clients now simply process charges entered in EHR/Practice Management, and the integrated ZirMed system automatically pulls and translates them to clean claims which are then submitted to payers. From there, using the unique claims history function, clients can monitor their claims' statuses at every step until reimbursement is complete. Bottom line, ZirMed offers our clients more control over their entire revenue cycle management function." Is this more than a product offering and a real trend? Yes.

In fact, Dr. David Blumental of the HITECH office, involved in writing the federal regulations, has indicated recently that the percentage of doctor's offices with EMRs have moved in the last two years from 19.6% to 29.6%. This past week the Office of the National Coordinator for Health IT has awarded two organizations with contracts to evaluate the effectiveness of electronic health records and the progress of health information exchanges.

So what are the revenue cycle management firms doing about it? It's a time of redefinition and new buzz words. McKesson has declared Horizon Enterprise Revenue ManagementTM supports the reinvention of revenue management practices, thereby creating a new category of financial management: enterprise revenue management.

Heads are rolling at some companies, and new blood is being brought in. For example, Streamline Health-- Solutions, Inc. (Nasdaq: STRM), a leading provider of document workflow solutions for hospitals, announced today that Robert Watson has been appointed President and Chief Executive Officer effective February 1, 2011. J. Brian Patsy, founder of Streamline Health Solutions and current President and Chief Executive Officer since its inception, has retired at the request of the Board of Directors from both positions and has also resigned as a director of the company.

For CIOs of healthcare institutions, there may be some answers at Revenue Cycle Management 2011, the DecisionHealth summit for physician practice revenue growth on August 7-9, 2011, in Las Vegas.

Selecting the best solution is more about knowing where you are at and what needs integration than it is about evaluation of an outside system before the fact. There are many flavors of ice cream, but until you know how hungry you are and what the flavor of the month choice is, the rainbow sherbet you've got looks mighty good.

Dawn Yankeelov will be speaking on ACOs at a Healthcare Transformations event regarding healthcare reform for rural hospitals in April 2011 in Lexington, KY.