5 Ways One Rev Cycle VP Combats Payers

Payer challenges continue to be a nuisance for revenue cycle leaders.

With slower claims processing times, algorithms denying claims without review, and vague policy details on behalf of payers, leaders are struggling to find solutions to keep claims out of limbo or unfairly denied. 

At HealthLeaders’ 2023 RevTech Exchange, Jonathan Benton, assistant vice president of Atrium Health offered attendees five solutions to combating such issues. 

Prioritization 

Use algorithms to score priority based on which accounts have the greatest potential value (ex. likelihood to recover/likelihood to deny) 

Automation 

Automate tasks to reduce work burden on people and prioritize processes to steadily speed up revenue cycle operations while reducing cost to collect. Example: Using bot technology for adding coverage or COB/eligibity denials. 

Cultivation 

Organize work to maximize system automated priority and embed daily behaviors and techniques. Use performance scorecards for self-directed improvements, measuring productivity and effectiveness to establish a standard. 

Analysis 

Focus on the root of an issue and be proactive rather than reactive. Keep track of factors impacting KPIs. Create strategic partnerships with physician advisors and vendors. 

Resilience  

Don’t let up on payers, and inundate them with appeals and follow up on automated denial responses. Be forward thinking and look at trends, develop insights, and observe what other organizations are doing.