Matt Seefeld is the executive vice president of 

. He has over 20 years of experience in revenue cycle management and is a leading expert in healthcare analytics and workflow automation.

Matt Seefeld

Sustainable, profitable positioning for today’s provider organizations hinges on the ability to capitalize on all revenue potential. The days of settling for 80-90 cents on the dollar are long gone as today’s provider organizations strive to increase margin within the framework of increased patient financial responsibility, the shifting payer reimbursement models and higher cost of labor.

Amid these changes, healthcare organizations face another significant challenge: unprecedented shortages of qualified billing staff and stiff competition on the recruitment front. Consequently, executives must not only achieve more with revenue cycle processes but must also have attractive systems in place that appeal to new hires and support staff retention for the long-term.

For Rebound Orthopedics and Neurosurgery, the team of physicians that supports the NBA’s Portland Trailblazers, the answer lay with implementing new technology-enabled workflows built on automation and effective intelligence. The right technology infrastructure helped the 75-provider, 16-location organization in Portland, Ore. and southwest Washington eliminate the practice of simply throwing resources at patient accounts and open claims and make informed, data-driven decisions instead of hiring more staff.

Effective Intelligence: The Power of Data-Driven Workflows

Data analytics has been a buzzword across the healthcare industry for over two decades now. And while many provider organizations have invested in some form of infrastructure to support “intelligence,” the question that needs to be asked is: Is the data making revenue cycle more effective?

Effective intelligence calls the user’s attention to the source of problems before they are obvious or stumbled upon, and doesn’t require a ton of experience or reliance on “gut.” It dives deeper into granular data that provide visibility into the effectiveness of each staff member and revenue cycle processes as a whole. With the right infrastructure of analytics and automation, provider organizations can answer key questions such as “Could I be overstaffed?” and “Who are my most effective team members?”

Without answers to questions like these, provider organizations have limited ability to identify process improvement opportunities and make the most use of existing staff resources. For example, Rebound Orthopedics’ goal is to reach the highest percentage of zero-touch claims as possible.

That means revenue cycle staff are doing the right activities and capturing the right up front that will result in the claim being processed and paid without human intervention.

Achieving that goal requires access to key information:

How many claims are currently being paid without human effort?

What is the reason for the manual work effort?

How many claims are denied or require edits?

How often are patient collections occurring post-visit?

What are the root causes of denials and edits, and where can education improve staff performance?

Where are financial clearance strategies falling short on the front-end, and what patient collection opportunities are missed?

Simply put, the higher a practice can drive its zero-touch claims percentage, the more likely the organization will get paid the expected amount in the shortest time which means fewer people will be required to manage the preventable denials and write offs later.

Taking Hold of the Big Picture of Effective Intelligence

The applications of effective intelligence are broad and should be applied holistically to address the full lifecycle of billing processes, starting on the front-end and extending to patient balance follow-up. At Rebound Orthopedics, data forms the foundation of this effort via a centralized data warehouse that brings together data from multiple sources—practice management systems, EHRs and workflow automation solutions.

The Rebound Orthopedics team is equipped to optimize revenue cycle through a framework that addresses:

Getting to zero-touch claims starts first and foremost with accurate pre-registration processes that promote upfront collection of patient payments. The right infrastructure of automation and analytics can improve the overall financial experience by keeping patients informed and engaged from the start. Front-office staff minimize avoidable denials by ensuring accurate documentation, insurance and demographic information is obtained upfront, which in turn informs the amount patients will need to pay.

Workflow automation and virtual communication tools are helping Rebound Orthopedics make the most of staff resources and gain needed transparency into a remote workforce. These tools automate manual tasks, speeding daily work and improving accuracy. The software “learns” over time which claims need attention first in order to maximize collections, and present daily priorities to the biller in precise order, rather than just doing the easy ones first on a hard day. The clear visibility into whether any given staff are following the specified daily order makes managing more rational and data-driven.

When patient payments are not collected on the front-end, mobile engagement tools meet patients where they are, and patient financial counseling services pick up the slack.

In addition to a more optimal revenue cycle, the effective intelligence solutions deployed by Rebound Orthopedics have also resulted in unforeseen benefits. The executive team now has visibility into how payers stack up across the organization’s revenue cycle on an apples-to-apples basis, with different RBRVS years normalized, and based on how the group is actually paid rather than the nominal conversion factor. Reporting tools provide immediate insight into which payors are managing to pay well below expected collections through contract terms that may have been missed relating to ancillaries, non-physician providers, assist fees, and strategic denials.

Today, Rebound is achieving better bottom-line performance with fewer FTEs. Zero touch claims that require no human intervention now account for 62% of total, and a closed balance net collection rate above benchmark at 98%.

The success that Rebound is having despite the compounding external challenges faced by all medical groups goes to show that revenue cycle strategies must morph to improve margin and make the most of available resources. Healthcare organizations can no longer afford to leave money on the table. Technology-enabled processes that draw on workflow automation and analytics can deliver more effective intelligence that drives considerable bottom-line improvement—and best positions providers for a sustainable future.

Matt Seefeld is Executive Vice President of

Articles

A first-hand look at how data analytics and workflow automation transformed revenue cycle for Rebound Orthopedics and Neurosurgery

Making the most out of limited staff resources and optimizing bottom-line performance with effective intelligence

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The COVID-19 pandemic has left a permanent imprint on the healthcare landscape—one that will undoubtedly follow the industry into the new year and beyond. The heightened role of technology, especially as it relates to the use of data analytics to inform operational decision making, proved a key differentiator for understanding the short-term impact and tactics required to survive. Data analytics continues to play a major role in strategic planning and decision making as the pandemic accelerates through the winter where making the wrong decisions based on feelings rather than facts could put a provider practice out of business.

Providers have not faced a shortage of revenue risks associated with the pandemic. Findings from a Physician’s Foundation 

 released in August suggest an 18% decline in U.S. healthcare spending during the first quarter of 2020, the steepest decline since 1959. Notably, nearly three out of four (72%) of physicians surveyed said they have seen a reduction in income as a result of COVID-19, and 8% had shut their doors.

Long-term sustainability necessitates that financial executives, providers and billing teams become proactive in understanding and mitigating financial risks. Manual efforts to predict cash flow and forecast financial health leave many organizations simply reacting to problems that surface, making them vulnerable to revenue problems that can quickly spiral out of control.

The good news is that organizations with the right data analytics tools in place are poised to stay profitable by drawing on deeper insights into the specifics of financial health that inform better workflow practices and improved revenue capture. Additionally, analytics that focus on employee productivity and effectiveness are critical for managing the cost to collect. The added complexity many physicians face with virtualized workforces—even for short intervals—can have material impact on revenue cycle performance.

Three key considerations for patient-focused telehealth

A Bird’s Eye View of Revenue Shortfalls

Providers have faced a perfect storm of revenue hits amid national efforts to respond to the coronavirus pandemic and keep communities safe. To free up beds and resources in anticipation of significant demand, the elective procedures that make up a sizable part of income for many health systems and surgery clinics were halted for several months in most places. Outpatient visits also dropped a whopping 60% in the wake of the pandemic.

Telehealth has proved a game-changer for many physician groups across the U.S., yet within a fluid regulatory landscape, reimbursement for these visits remains largely untested. History confirms that in times of rapid change, billing errors increase—and so do claims denials.

Readiness for the unknown should be the mantra of all healthcare organizations heading into 2021. Already operating with razor-thin margins, providers cannot risk leaving money on the table. And with the pandemic still not under control, it is even more imperative that healthcare providers have the strategies and insight to weather the storm and stay in business.

Optimal strategies going forward draw on technology-enabled workflows and real-time analytics to stay one step ahead of operational losses and revenue cycle bottlenecks. Financial executives should leverage financial forecasting tactics that deliver a holistic understanding of organizational financial health. These include:

Along with real-time visibility into appointment volumes, healthcare organizations need to understand what missed visits equate to in revenue losses. This way, there is time to prepare for fixed cost reduction, such as payroll expenses or surgical supplies.

Analytics can help practices know how quickly a decline in services will impact cash flow to inform current and future decision making. In addition to year-over-year period comparisons, practices should pay attention to the dropoff in insurance and patient payments as well as changes to payer mix and its related financial impact.

Understanding the number of cancellations that have occurred compared to the number of patients rescheduled is another important forecasting metric. With the right analytics tools and approaches, practices can see these comparisons in real-time across several months. It is also important practices understand how to reschedule to maximize net revenue which could be based on a combination of factors like episode of care and payer.

A clear view of how much money a practice has and when it can expect to collect for services rendered is foundational to understanding financial health. Billing departments that draw on real-time analytics can instantly differentiate between the total balance of accounts receivable (A/R) versus the actual value, such as denials, past due patient balances, claims that have yet to be filed, and partial pays.

Strategy checklist for medical practice acquisitions

Providers should prepare for an increase in denials due to the introduction of new codes and care delivery models. With visibility into denied claims, billing teams can identify the categories and probability of overturn. For example, hard denials, such as no authorization or maxed benefits, will likely hold true. However, others might be resolved with a quick change to a modifier.

The coronavirus pandemic has ushered in many challenges for today’s providers. The good news is that there is no need for financial executives to get caught off guard again. Analytics tools can deliver real-time visibility into the revenue cycle, equipping healthcare organizations with the insights they need to proactively monitor reimbursement trends, forecast collections, and make informed decisions to effectively manage the bottom line and ensure long-term sustainability.

Manual efforts to predict cash flow may leave you vulnerable to revenue problems that can quickly spiral out of control.