Rebounding from the extreme financial strains of COVID-19 requires a hard look at your revenue cycle and how it is maintained: Where are the opportunities to improve patients’ experiences and address their demands to “go contactless”? How can your revenue cycle and front-office teams work efficiently? Are you maximizing every revenue opportunity, especially from value-based care programs?
During the pandemic, many physician groups mainly focused their attention and resources on patient care and clinical outcomes, so now is the perfect time to look at rebuilding revenue.
With this renewed focus and five key strategies—tested and proved by physician groups—you can emerge from the crisis positioned for financial growth and lasting stability, with a plan to adapt to the changing landscape and patients’ evolving demands.
Patient experience platforms are the foundation for the digital front door, where patients can handle the administrative side of health care from their digital devices, wherever they are, at their convenience. With mobile appointment scheduling, contactless check-in processes, and virtual care offerings, these platforms help providers engage with patients in a safe and personalized fashion while freeing up valuable staff time.
Holston Medical Group (HMG), an independent physician group with over 165 providers in the Southeast, uses its newly implemented patient experience platform to send out frequent reminder communications and allow patients to self-schedule, reschedule, or cancel appointments. As a result, HMG has significantly decreased overall patient no-shows and cancellations and increased overall patient volume. Additionally, with online bill pay functionality, HMG took in $120,000 in patient payments in the first month of deployment, increasing to $337,000 a month by the end of 2019.
Inadequate revenue cycle management processes and a lack of specialization in key areas such as charge capture and coding have decreased the effectiveness of many physician groups’ central billing office (CBO). Organizations like District Medical Group (DMG), a not-for-profit 650-provider integrated medical group, have overcome these challenges by shifting billing operations management to an end-to-end revenue cycle partner.
Before this partnership, DMG’s CBO structure was fraught with manual processes that slowed production—especially in relation to charge capture and posting. These inefficiencies led to a significant backlog of over 60,000 patient records that needed to be coded.
DMG knew they needed help and transitioned their revenue cycle responsibilities to an outside partner that had the specialization, technology, and resources to improve financial performance, reduce expenses, and simplify administrative burdens. Since establishing the partnership in March 2020, DMG cut billing costs by 4% and fully caught up on its backlog of coding work in only 10 weeks. In just a few months, DMG also more than doubled its charge output, going from $10 million charges posted in May 2020 to $22.75 million charges in July 2020.
While contract management requires a significant amount of prep work and analysis, it’s a major financial opportunity. You can potentially increase reimbursement rates with all or most of your payers by working with a partner who helps actively manage and structure these contracts.
One Pediatrics, a multi-practice group in Louisville, KY, worked with their revenue cycle partner to conduct an in-depth evaluation of contract inventory to ensure they were being paid fair market value. The group analyzed Current Procedural Terminology (CPT) codes, payer rates, and payment history; compared rates across all payers and regional benchmarks; and identified gaps and opportunities for additional revenue streams. One Pediatrics used this data to negotiate per-member-per-month rates from $2.85 to $3.35. As a result, One Pediatrics increased practice revenue by more than $100,000 each year.
Complete and accurate coding can directly impact reimbursement and improve care delivery—especially for high-risk patients—as value-based payment models gain popularity and enrollment in Medicare Advantage plans continue to increase. By having the appropriate tools, expertise, and procedures in place, your group can improve clinical documentation integrity and see financial improvement.
At Cape Fear Valley Medical Center, a southeastern multispecialty practice, staff members realized they were only receiving about one-fourth of their projected bonus allocation in quality programs and needed to update their coding program. The practice was counseled to use Hierarchical Condition Category (HCC) Coding, implement an annual wellness visit (AWV) outreach program, and procure a certified risk coder to create electronic health record templates that facilitate accurate capture of patient diagnoses. In January 2020, the practice nearly quadrupled year-over-year AWVs and achieved an annualized net improvement of more than $400,000.
When physician groups have access to real-time patient data in clear and actionable reports, it creates transparency and helps leadership lower costs, improve communication, plan staff allocation, and project future volume.
Hawaii Emergency Physicians Associated (HEPA), the largest emergency physician group in Hawaii, needed data analytics to model anticipated staffing levels across the hospitals they served. With the assistance of a partner, HEPA implemented a dashboard program that optimizes staffing hours by matching patient arrivals to provider capacity—which allows HEPA to provide fast, high-quality care. This dashboard also condensed more than 145,000 patient records into one location that staff members can easily access, enabling the group to track physician call-backs, discharged length of stay, and clinical pathway compliance and use. HEPA has grown from serving four hospitals to nine and saved $500,000 in operational costs.
End-to-end revenue cycle partnerships can deliver significant results—improving the patient experience, streamlining staff workflows, and increasing financial performance. Instead of trying to do it all, it’s time to determine how your group can focus on its mission and what it does best—delivering proven expertise, innovation, and the highest quality care.
Vijay Kotte is the executive vice president of physician services at R1.