3 Great Revenue Cycle Exchange Ideas

"Charge segregation," empowering SBO reps, and demythologizing point-of-service collections were among the great ideas presented last week at the HealthLeaders Revenue Cycle Exchange.

One of the most interesting parts of the HealthLeaders Revenue Cycle Exchange is the opportunity for individual leaders to present successful, real-world case studies to their peers during a segment we call the "ideas exchange."

Several executives took the opportunity to share their work during last week's Exchange in West Palm Beach, Florida. Here are three of them:

1. Taking charge of "charge segregation"

Angela Simmons, vice president of revenue and reimbursement at Vanderbilt University Medical Center in Nashville, Tennessee, described how they developed a process of segregating charges according to the reason for the patient visit, so unrelated charges aren’t applied to an existing bundle.

She used as an example a recent transplant patient who was involved in a car accident soon after the transplant. When he came to the facility again as a trauma patient, a realization "washed over" her.

"That was a separate event," she said of the trauma care. "If you don’t do something about it, it will just flow into that fixed payment, and you won't get paid."

Charge segregation allows revenue cycles to identify additional billable services that would have otherwise been packaged to the bundle. Simmons used as another example a pregnant patient having an eye exam that's unrelated to their pregnancy care.

"If the pregnancy diagnosis is on the claim, it's going into that bundle unless I do something about it," Simmons said. The goal, she said, is to "not leave any money on the table."

Now, Simmons says they have lists of charges that are always, sometimes, and never part of certain bundles. Having fixed "never" and "always" charges allows them to be segregated using automation, while the "sometimes" charges are reviewed by a person.

"If your executive leadership wants to get into alternative payments, we need to be thinking about this now," Simmons said.

2. Empowering your shared business office employees

For Terri Meier, system director for patient revenue cycle at UC San Diego Health, forming a shared business office (SBO) was about more than consolidating call centers: It was also about empowering customer service representatives.

"San Diego was really committed to making customer service our differentiating factor," she said.

With that in mind, she rewrote the customer service job description, making it a more challenging and dynamic role.

Now, the SBO staff are the highest paid in the revenue cycle.

"Customer service is the place on the career path that you want to go," she said. "I'm really hiring knowledge workers."

The SBO staff have also been critical in designing their own workflow.

The ownership and knowledge that SBO staff have over their roles are especially important given the call volume: Just 38 or so employees filed more than 700 calls per day.

"Having to manage that call volume and still meet our goals is critical to our success," Meier said.

3. Demythologizing point-of-service collections

There's a myth about point-of-service (POS) collections, believes Michael Berger, director of revenue cycle​ for Saint Peter's Healthcare System in New Jersey.

"Point of service is not the be all, and end all," he said.

Facing a climate in which high out-of-pocket costs, high demand for payment plans, and stagnating collections are the reality, the Saint Peter's revenue cycle recognized that it already had a number of key building blocks in place for collecting patient balances.

Those included a very strong pre-service process for verifying insurance and benefits and producing patient estimates, as well as well-trained financial counselors. 

In order to build on those strengths, they also employed several additional tactics:

• Using an EBO vendor to proactively follow-up and collect on the most liquid patient balances
• Offering patient financing with zero interest for up to 36 months​
• Requiring all patients who want a payment plan to enroll in its patient financing option​

Doing so has yielded impressive results, including reducing bad debt by 30%; reducing payment plan defaults from 22% to 2%; and increasing collections by $2.3 million.

"We have bucked the trend in the industry of bad debt," he said.