Accounts Receivable Success – The Teaming of Information and Revenue Cycle Operations
By Ben Tobin
Engagement Manager
Beacon Partners, Inc.

You’ve heard it before, the health care business is getting more complex everyday. There are more demands on everyone involved in the Revenue Cycle, and we are all being called on to perform more and increasing complex roles. The bottom line is - it’s getting harder to get paid for the clinical services our practices perform, and more obstacles are being put in our way.

If we do indeed realize this, the most important question we can ask ourselves is, “what are we going to do about it?” The simple answer is – we need better information and we need it now. We need to know more about every aspect of the revenue cycle. Information is the only way to accurately identify problems and formulate a proper plan to respond effectively. Information must also be able to help us evaluate if the steps we have taken have been effective.

Information system purchases and upgrades have been one of the largest expenditures impacting the industry in the past few years. One of the intents of these expenditures was to better understand and control the many functions of the Revenue Cycle. While this is truly a worthwhile goal we have seen the ability to produce reliable information fall short of expectations. Some of this has to do with system infrastructures, but more of it lies with the lack of understanding of what data can be extracted from the system and failing to apply the correct resources and knowledge to the task. Many organizations understand that the information they need to make decisions to correct Revenue Cycle processes is available, but many are stymied because they are not able to extract the information or make sense of the findings. But the ultimate problem is that many do not know where to turn to get the information.

The solution to this problem includes developing a team that combines analysis knowledge with data extraction expertise. An organization must begin with a basic examination of the Revenue Cycle structure. This begins with a comprehensive review of claim production, denials, rejections, and system edits. Again, the value of this first step depends on the quality of information gleaned from data history, and in-depth analysis of the information. This analysis must be clear enough to identify where in the revenue cycle the process failed to gather or verify information that would secure reimbursement for the service rendered. This step will also form the basis for an action plan. The forming of a team provides the advantage of viewing issues from many points of view and properly interpreting the information gathered.

In many organizations one of the most important structural changes we have seen is the creation of an analyst position within the Accounts Receivable function. The most successful of these organizations have teamed the analyst with a data extraction expert, many times from the Information Technology department. The analyst is typically well versed in the use of report writing and spreadsheet software. However, having the ability to tap into data extraction expertise produces the most efficient and effective response to reimbursement problems. The analyst knows what information needs to be examined; the IT data expert knows where to find the data, how it is formatted, and how to extract it. This also sets up the necessary check-and-balance regarding the quality of information.

The Accounts Receivable process has been going through many evolutions. To be successful, organizations must adapt in various ways. Disseminating information and providing quality analysis is key. Historically, the Accounts Receivable process has included billing production, edit resolution, denial follow-up, and patient balance collection, while the Information Technology role has been safeguarding the integrity of the practice management system, hardware and software support, network infrastructure, and vendor liaison. The next step in this evolutionary process is A/R and IT teaming to become the ‘Revenue Cycle Monitor’.

This monitoring role begins with the development of key indicator tools for each segment of the Revenue Cycle – Appointment Scheduling, registration, insurance verification, charge entry, billing production, cash collections, A/R aging, payment posting – to name just a few. But the quality of any key indicator measure depends on two important factors – (1) determining what needs to be monitor, and (2) where should the information come from. The answer to these two questions is found in the collaboration of the traditional Accounts Receivable and IT functions.

It is not enough to create this Team, design the key indicator tools and then revert back to the traditional roles. As was mentioned earlier, the business we are in is constantly changing and becoming more complex. Because of this, organizations have to constantly examine how they do business, and recognize what obstacles are standing in the way of gathering reliable information in order to respond in a proactive way to a shifting business environment. We need only to look at our own organizations to understand this every changing business – fee schedules adjustments, additional services are introduced, billing formats are modified, auto-remits requirements change, servers are updated, PCs are replaced, staff turnover – to understand what we are facing. The characteristic of a successful organization will be the successful teaming of Revenue Cycle operations and IT data gathering expertise.

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About the Author
Ben Tobin is an Engagement Manager with Beacon Partners. Ben has over twenty years of experience in the health care industry, primarily in the Physician Practice Management and Hospital Accounts Receivable Management sectors. His experience includes daily operations of multiple sites, revenue cycle management, analysis, development of strategic planning, human resource management, financial report development and regulation compliance. He is well versed in Management Services Organizations and fully understands the infrastructure requirements of Health Care Integrated Delivery Networks. Mr. Tobin can be reached at 781-982-8400 ext. 437, or btobin@beaconpartners.com.