Revenue Cycle Steering Committee Improves Financial Health

October 10, 2019 - Leaders consider North Valley Hospital in Whitefish, Montana a community hospital. But for revenue cycle management staff at the non-profit, critical access hospital with 25 beds, that sense of community didn’t always translate to their work.

Despite employing a little over 400 team members, including about 176 physicians, North Valley Hospital still experienced the silos traditionally seen in larger hospitals, including the separation of revenue cycle management teams from clinical departments and even each other.

But when the small hospital’s financial health took a turn for the worse, leaders at North Valley Hospital decided that it was time to bring a sense of community to revenue cycle management.

“When you look at the big picture, it's more than just the business office, registration, and health information management. It takes a village to make sure your charges are getting in on time and that there are systems in place to get the most reimbursement and a clean claim going out the door,” Laurie Pierce, the hospital’s patient financial services director, told RevCycleIntelligence.com.

With hospitals writing off 90 percent more claim denials compared almost a decade ago, ensuring the village works effectively and efficiently is key to keeping organizations financially healthy.

READ MORE: 4 Key Ways to Improve Healthcare Revenue Cycle Management

With this in mind, leaders at North Valley Hospital created a revenue cycle steering committee.

Developing a revenue cycle steering committee

A revenue cycle steering committee brings together leaders from patient financial services, health information management (HIM), nursing, outreach clinics, compliance, and even the CFO and CIO to examine revenue cycle management performance on key performance indicators (KPIs) such as denial rates, days in accounts receivable (A/R), and cash collections.

With an eye on revenue cycle management performance, hospital leaders then discuss strategies on how to improve specific KPIs whether it be through the organization’s billing workflows or even at the point of care, explained Stephanie Fleming, the committee’s meeting facilitator.

“With registration, for example, we're tracking things like point-of-sale collections, preregistration rates, and complete registrations to see how those impact how we’re billing and how we get a clean bill out of the door,” she said in an interview. “It’s really important that each part of that process is not seen as separate. We're all part of a team and that's shown through the committee. It starts from the beginning and it goes from the ground up.”

The revenue cycle steering committee enables the community at the hospital to see and understand financial performance, as well as enact process changes that ensure the organization sends out as many clean claims as possible. Alignment across departments is critical to gaining the buy-in needed to effectively and sustainably implement changes for successful billing.

READ MORE: Key Ways to Start A Hospital Revenue Cycle Turnaround Process

For North Valley Hospital, for example, the steering committee really helped to “regain that engagement with the ancillary departments to get their buy in for revenue cycle improvements,” said Tesa Topley, HIM director.

And with greater buy-in, the hospital has seen significant improvements.

North Valley Hospital has seen their days in A/R and claim denials decrease because of changes implemented through the revenue cycle steering committee, Pierce reported. The hospital now runs between 42 and 44 days in gross receivables and days in net receivables is about 23 to 24 days. The hospital also provides less charity care and collects more payments from patients at the point of care, she said.

Open communication is key to success, Topley emphasized. “Because ancillary departments may not know of all these changes that we see on the financial end like Medicare rules and regulations, they may not be seeing that. But we do, and we can now share that information with them.”

Successful steering committees tackle specific projects

Using the revenue cycle steering committee to tackle specific, agreed-upon KPIs or initiatives is what makes the group at North Valley Hospital so successful, the hospital leaders agreed. For example, they focused on decreasing denials stemming from prior authorizations this year.

READ MORE: Patient Financial Experience the New Focus for Revenue Cycle Tech

“Montana’s Medicaid program requires patients who are receiving services to contact their Passport provider ahead of the procedure and get that authorized,” she said regarding the state’s primary care case management initiative, Passport.

“We were missing that a lot of the time and our claims were getting denied. Then, back end registration or the business office would have to call the doctor's office, get an authorization after the fact, and resubmit the claim for payment,” she continued.

The revenue cycle steering committee picked up the issue and identified improvements that staff across the organization could implement as part of their workflows to ensure Medicaid patients received an authorization prior to service delivery.

“Now, we're just down to a handful of accounts each month getting denied,” Pierce said. “And we just put in a couple of little steps and routines in place for monitoring.”

Point-of-sale collections was also a major win for the revenue cycle steering committee.

“Our point of sales collection is a big one to mention because we've seen some huge growth with that and it's gotten competitive amongst not only the hospital staff but also the clinics that we have,” Fleming added. “So, we report that measure once a month and we always try to give major kudos for trying to get that point of service collections collected. So far, our rural health clinics have done exceedingly well.”

As the patent financial services director, Pierce is using that information to motivate her staff at the hospital to improve point of service collections and implement best practices from the rural health clinics.

Moving forward, the committee is focusing on improving obstetrics (OB) registration. Hospital leaders plan to revamp OB pre-registration by identifying patients through ultrasound services who need insurance or might require financial assistance.

By pre-registering OB patients, North Valley Hospital can help enroll patients in Medicaid and improve the organization’s bottom line. But pre-registration will also help the patients, Pierce stressed.

“We want all our OB patients to take a tour of our OB services and understand how our billing system works,” she stated. “We explain to them that they are going to get a bill for the mom and for the baby. So, when they come in to deliver, our financial counselors will not have to visit them in the room. They'll know all about their bill and they can go right back to OB without having to go through that process again.”

Patient experience and patient financial responsibility are hot topics for hospitals. With patients owing more out-of-pocket, providing a high-quality experience not only benefits the patients who want value for their money, but also the hospital seeking payment for those services.

By bringing leaders from across the organization together, revenue cycle steering committees are enabling hospitals to address their most pressing challenges and implement system-wide process improvements.

“Having the revenue cycle branch out to the ancillary staff and vice versa to get more of a community feel and eliminate silos has really helped out our finances here at the hospital,” Topley concluded.