Providence St. Joseph snaps up blockchain-powered RCM platform Lumedic

Lumedic’s next-generation platform uses distributed ledger technology, smart contracts and machine learning with the aim of selling to providers and …

Dive Brief:

  • Providence St. Joseph Health has acquired Lumedic, a blockchain-enabled revenue cycle management platform based in Seattle, for an undisclosed sum.
  • Lumedic’s next-generation platform uses distributed ledger technology, smart contracts and machine learning with the aim of selling to providers and payers looking to increase efficiencies and reduce costs.
  • The deal makes Providence St. Joseph the first integrated provider-payer system with a scalable blockchain tool for RCM, the nonprofit system said Monday at HIMSS 2019 in Orlando, Florida.

Dive Insight:

RCM is an important area to providers, and a number of vendors are seeking to capitalize on it.

In a Connance survey, 70% of providers claimed it took more than a month to collect from patients. A 2017 Advisory Board analysis found the average 350-bed hospital lost up to $22 million due to revenue cycle issues. Respondents in a recent Billing Tree survey ranked collecting on patient bills the No. 1 payment challenge in 2018.

With pressure to boost financials, hospitals are eager for tools to optimize the billing and collection process and improve the customer experience. The major EHR vendors, as well as other companies, are investing in RCM products as demand for these kinds of services grows. Last year, officials at both Cerner and Allscripts touted RCM as strong growth areas.

Demand for RCM tools and services is also fueling consolidation in the market. Among notable deals was R1 RCM’s February 2018 acquisition of Intermedix’s healthcare division, which includes physicians and emergency services RCM, practice management and analytics.

The Lumedic deal is the latest piece in what Providence St. Joseph officials have described as a “broader vision of healthcare.” Earlier this month, the system launched a for-profit population management company called Ayin Health Solutions. The business will assist providers, payers, employers and governmental department seeking to reduce costs, enhance care and improve population health.

“New technologies like blockchain, artificial intelligence, and machine learning give us an opportunity to view the complexities of today’s health systems through a different lens,” Venkat Bhamidipati, Providence St. Joseph’s CFO, said in a statement. “Our acquisition of Lumedic’s innovative platform is yet another example of how we are pursuing all avenues of transformation, allowing us to redirect unnecessary spend towards either patient savings or care.”

Under the deal, Providence St. Joseph will create a new company with Lumedic’s assets and team, while retaining the Lumedic brand. The RCM business and system will work together to identify potential partnerships with providers, payers and other health-related entities.

The acquisition comes as Tenet Healthcare has been mulling the sale of its Conifer Health Solutions RCM subsidiary as part of a target cost-reduction program to bring down debt. The Wall Street Journal reported last summer that UnitedHealth Group was among several entities interested in the business as it continues to build up its Optum services arm through acquisitions.

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Providence St. Joseph Health acquires revenue cycle management blockchain startup

The platform builds on distributed ledger technology, smart contracts, and machine learning to deploy a more efficient revenue cycle, from eligibility to …

Providence St. Joseph Health has acquired Seattle-based Lumedic, a revenue cycle management company based on blockchain technology, with the aim of streamlining data sharing and improving claims processing.

The Renton, Washington-based health system announced at the 2019 Healthcare Information Management Systems Society (HIMSS) Annual Conference & Exhibition that it plans to leverage the blockchain platform to reduce inefficiencies in revenue cycle management. Terms of the deal were not disclosed.

Traditional health system and hospital revenue cycle processes frequently rely on physical correspondence and fax machines for sending medical records, legacy systems for data storage, and employees who spend hours calling insurers on the status of claims. In addition to the cumbersome workflow, healthcare billing and claims is still largely a manual process, which introduces the potential for errors.

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Revenue cycle inefficiencies were responsible for more than $500 billion in U.S. health care costs in 2018 alone, largely due to industry complexities and manual processes, according to a McKinsey & Company analysis.

Providence St. Joseph Health, a not-for-profit Catholic healthcare system operating multiple hospitals across five states, said it is the first integrated provider-payer system to establish a scalable blockchain platform to modernize claims processing and enhance interoperability between providers and payers.

“New technologies like blockchain, artificial intelligence, and machine learning give us an opportunity to view the complexities of today’s health systems through a different lens,” Venkat Bhamidipati, Providence St. Joseph Health chief financial officer, said. “Our acquisition of Lumedic’s innovative platform is yet another example of how we are pursuing all avenues of transformation, allowing us to redirect unnecessary spend towards either patient savings or care.”

RELATED: Aetna, IBM launching new blockchain healthcare network

“By disrupting these often cumbersome processes ourselves, we strive to lower administrative costs for both parties while getting deeper insight into the financial experience of patients and the ways we can simplify the process for them,” said Rhonda Medows, M.D., Providence St. Joseph Health president of population health and chief executive officer, Ayin Health Solutions.

Several healthcare collaborations have launched in the past year with a focus on using blockchain technology for healthcare use cases, with many initiatives aimed at increasing efficiencies in administrative processes. Insurers Aetna, Anthem and Health Care Service Corporation recently announced a collaboration with IBM to launch a blockchain healthcare network to address a range of industry challenges, including “promoting efficient claims and payment processing and maintaining current and accurate provider directories.”

In December, Change Healthcare bolstered its existing blockchain platform by acquiring blockchain startup PokitDok.

Lumedic, which launched last year, uses blockchain technology to modernize the financial operations of healthcare by creating more price transparency and speeding up the billing and claims process for healthcare providers, the company said. The platform builds on distributed ledger technology, smart contracts, and machine learning to deploy a more efficient revenue cycle, from eligibility to pre-authorization to billing.

RELATED: Change Healthcare bolsters existing blockchain platform with PokitDok acquisition

According to Lumedic, blockchain technology has the potential to modernize revenue cycle management as distributed ledgers are collaborative databases which allow multiple parties to share data with each other securely, privately and efficiently. As healthcare is a collaborative industry, requiring communication between payers, providers, and other third parties, blockchain technology can be valuable when changes to contract terms become necessary, the company said. The use of blockchain technology also can enhance the patient financial experience by providing “an always current, transparent, accurate and secure single reference point for patients with information from all parties.”

The health system has acquired Lumedic’s assets and team and plans to form a new company that will maintain the Lumedic brand. Lumedic will work with Providence St. Joseph Health sign up partnerships with providers, insurers, and other healthcare stakeholders.

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Health Systems Realize Significant Financial Benefits from AI-driven Revenue Cycle Solutions …

DENVER, Jan. 29, 2019 /PRNewswire/ — The nation’s premier integrated care delivery networks are replacing expensive and time-consuming manual …

DENVER, Jan. 29, 2019 /PRNewswire/ — The nation’s premier integrated care delivery networks are replacing expensive and time-consuming manual financial clearance solutions with AI-driven automation by Recondo Technology, the company announced. Recognized in 2018 as Best in KLAS for patient access software and solutions, Recondo made notable additions to its client base in 2018. Providers are drawn to the automated payer communication that processes large transaction volumes in a fraction of the time and cost it typically takes their staff. The results are increases in pre-service cash collection, reductions in denials and timely write offs, and huge resource efficiency gains.

“Epic” results for Bon Secours Mercy Health

In early 2018, Recondo launched RevSmart, which embeds automated payer communication directly into the Epic system via Epic’s real-time eligibility (RTE) and real-time authorization (RTA). Bon Secours Mercy Health was one of the first customers, along with its revenue cycle outsourcing partner Ensemble Health Partners, to select RevSmart to automate financial clearance activities. As a result, Bon Secours Mercy is now automating eligibility, authorizations, medical necessity and pre-service estimations, as well as utilizing Recondo’s ClaimStatusPlus solution in the business office.

Coupled with best in class workflow and Ensemble-led optimization of the HIS system, Mercy has since seen a 50 percent gain in pre-registration and authorization days out, and point-of-service collections are up 95 percent in the first six months of implementation. In addition, Ensemble was able to reallocate 118 FTEs, resulting in $7.6M in FTE cost savings for Mercy Health.

In total, the combination of RevSmart and Ensemble’s focus on operational execution have resulted in a $15M net revenue increase in a single year.

“Embedding Recondo’s revenue cycle automation capabilities and content into Epic, in combination with Ensemble’s KPI-driven workflow maximization, have driven results beyond our expectations,” said Shannon White, Chief Operating Officer of Ensemble Health Partners. “We’re excited to see how our expanding revenue cycle services, combined with new developments in Recondo’s technology with respect to machine learning and natural language processing will automate more manual processes for our clients.”

New customers for automated claim status checking

Recondo customers are also reaping returns by automating retrieval of enriched claim status data from payer websites, enabling expedited and intelligent workflow routing and making 80% of claims “touchless” in the business office.

Historically, this function has required considerable staff, who could never reach the end of an endless backlog of claims needing follow up through manual effort. With Recondo’s ClaimStatusPlus™ solution, new customers such as Montefiore Health System, Henry Ford Health System, Spectrum Health, and Stormont Vail can process tens of thousands of outstanding claims in a matter of hours.

For customers like Avera Health, this newfound efficiency has resulted in cash flow improvements of over $20 million. Avera Health’s Vice President of Central Business Office, Mary Wickersham will be presenting the results of robotic process automation for claim status in Session 79 on Tuesday, February 12 at 4:15pm PST in Room W308A at the upcoming HIMSS19 Annual Conference.

Accolades for innovation

In 2018, Recondo was the first company to receive the coveted HFMA Peer Reviewed status for automated authorization and claim status verification, which contributed to expanded services to existing customers including Avera Health, University of Colorado Health, among others.

Recondo’s leadership in AI-driven technology for revenue cycle management was also featured in multiple publications, including Healthcare Finance News, HFMA’s Revenue Cycle Strategist, Inside Big Data and others. The company pioneered the use of robotic process automation to query, retrieve and normalize answers from payers in multiple data formats, and today, is further innovating this capability with machine learning and natural language processing to make communication with payers virtually touchless.

“Strategic partners like Ensemble, and other forward-thinking clients, push Recondo not just to continuously innovate our AI technology platform, which has led the market from the earliest stages of RPA, but to do it in collaboration with workflow design and system integration. This powerful combination results in highly scalable solutions that quickly drive transformative business impact in the tens of millions,” said Jay Deady, Recondo’s CEO. “Look for next generation AI like machine learning and natural language processing to be powering our solutions in 2019.”

Recondo leadership and customers will speak about and demonstrate these capabilities at various industry events in 2019, including HIMSS19 in Living Room #3 and Session 79 where customer Avera Health is co-presenting with Ryan Ayres, Recondo’s Senior Vice President of Strategic Solutions; in Booth PL3 at HFMA Region 5’s Dixie Institute on February 24; at the CORE User Group meeting on February 27; and HFMA’s Annual Conference in June.

About Recondo Technology

Recondo’s cloud-based solutions deliver industry leading automated, accurate, and actionable financial clarity to all participants within the healthcare revenue cycle. Recognized by Black Book Research as one of the top three leaders in revenue cycle management software, Recondo empowers more than 900 hospitals with solutions that connect providers, payers, and patients to ensure proper payments across the care continuum. The company’s patented software and expertise streamline operations and allow providers to be paid more, faster, and at a cheaper cost. Recondo brings efficiencies and cost savings to patient access through to payment processing—a continuum today where inaccuracy and inefficiencies currently cost U.S. healthcare a staggering $480 billion per year. Learn more at www.recondotech.com.

Media contact:

Stephanie Janard

Amendola Communications for Recondo Technology

sjanard@acmarketingpr.com | 828.962.2054

SOURCE Recondo Technology

Related Links

https://www.recondotech.com

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Using Artificial Intelligence to Improve the Hospital Revenue Cycle

Using Artificial Intelligence to Improve the Hospital Revenue Cycle … This intelligence-based category of automation tools frees staff from necessary …

Sponsored by Olive

January 28, 2019 – Each year when they draft their budgets, hospital CFOs and other financial leaders are challenged to find ways to cut costs while maintaining high-quality services.

Fewer dollars are flowing into hospitals because of changes to the care delivery landscape, and the cash hospitals have available is often spent on emergent necessities, such as data security, attracting and retaining top talent, or overdue facility upgrades.

Coupled with the growing number of patients enrolled in high-deductible health plans and lower commercial payer and Medicare reimbursement, CFOs are forced to be creative with the resources they have so their organizations can accomplish the most with the least.

Healthcare’s high-cost problem is systemic, and the onus is on healthcare organizations to identify the root causes of their high-cost areas and think outside the box to drive some of those expenses down.

The financial drivers CFOs care about most

Throughout my years in healthcare, I have come to understand the challenges hospitals and their CFOs face in budgeting.

READ MORE:Mid-Revenue Cycle Management, CDI Market to Reach $4.5B by 2023

A hospital CFO’s number one objective is keeping the organization’s doors open. CFOs zero in on their hospital’s overall operating margin and the operating margins of each individual service line.

So, what has the biggest impact on operating margins? Labor costs typically eat up more than half of a hospital’s operating revenue, and that allotment is poised to increase as organizations face continued pressure to raise salaries and wages. Hospitals are now rethinking the roles of some employees.

The revenue cycle is one area of the hospital that is labor-intensive. Hospitals have to ensure their organizations are paid for services rendered or, in other words, that they collect payments from patients and payers. Financial leaders need to consider revamping their organization’s approach to revenue cycle management.

Common holes in the revenue cycle

Hospitals are constantly battling denials as payers require authorization for more types of procedures or adjust policies without any notification to providers. A denied claim triggers effects that spill over to disrupt other aspects of the hospital’s finances. For example, after a payer denies a claim, administrators are forced to chase the denial, which often requires multiple calls to the ordering physician and working closely with the payer. This is a time-consuming, and not always rewarding, process. The claim then sits in accounts receivable until it is adjudicated, which takes days to months.

Reprocessing claims drives up labor costs as billing staff is forced to devote more time to unpaid claims. According to research from the American Medical Association, the industry could save $15.5 billion each year if companies processed claims correctly the first time.

READ MORE:Accounting for the Patient in the Healthcare Revenue Cycle

The hospitals and health systems I have worked with have pointed toward lower dollar accounts as another key area where revenue is lost or delayed. That is because hospitals often lack sufficient resources — such as staff or budget — needed to touch each and every patient account. What ends up happening is organizations focus primarily on the high-dollar accounts, which means many low-dollar accounts slip through the cracks. Unfortunately, all those missed payments from low-dollar accounts add up.

Hospitals often turn to an outsourced vendor to tackle these low-value, high-volume accounts. But similar to in-house teams, these outside partners aren’t always able to physically act on all accounts.

On the bright side, there’s a potential solution for this persisting challenge: inserting AI into revenue cycle processes.

Improving the revenue cycle, starting with artificial intelligence and automation

As leaders devise revenue cycle improvement plans, they should consider how proposed solutions could affect bottom lines and operating margins. Leaders should also determine the resources needed to fulfill plans, such as an outsourced partner or a tool built in-house or purchased elsewhere. AI-enabled automation is one such tool that may help.

This intelligence-based category of automation tools frees staff from necessary but redundant and time-consuming tasks, and it enables the organization to reposition skilled workers toward meaningful quality assurance programs within the revenue cycle. Automating some processes within the revenue cycle is an affordable way for organizations to reduce labor costs and recover leaked revenue since it enables organizations to touch both high- and low-dollar accounts.

READ MORE:Artificial Intelligence Ensures Payer, Provider Pay Covers Costs

When hospitals automate portions of the revenue cycle, they can execute a higher volume of claims at a cost-effective rate and regain their edge. And as the machine learning components of this automation learns, it unleashes meaningful insights to the organization and allows for ever-more opportunities for efficiencies.

Automate the mundane using AI to move employees into modern roles

AI in the revenue cycle is really about revenue integrity, a hospital’s ability to achieve operational efficiency, compliance, and optimal reimbursement. The technology allows hospitals to repurpose employees and mitigate revenue leakage in ways that require more critical thinking.

Automation takes high-volume, repetitive, and mundane tasks off employees’ workloads, allowing hospitals to expand production at a much lower cost. Hospitals can then re-invest these freed up resources into those tasks that require a more human touch such as empathy, creativity, and complex thought.

AI allows organizations to do a few things differently with their revenue cycle staffing and strategy.

First, with redundant tasks accounted for via automation, hospitals can strategically reassign skilled workers to duties they’ve historically struggled to fill or to non-urgent but essential projects that have sat too long on the backburner.

Second, AI enables organizations to address workforce shortages. For example, rural markets often have trouble attracting top talent and may struggle to fill important positions. On the other side of the coin, hospitals in competitive markets may struggle to retain employees they have invested in. By automating portions of the revenue cycle, rural hospitals can move loyal and committed staff members into positions that have been difficult to fill due to talent shortages.

Third, AI can help talent retention in more competitive markets, as hospitals can reward loyal employees with more consequential roles as they are no longer needed for tasks that can be completed with automation.

Moreover, AI enables healthcare organizations to be more strategic with the work they outsource. Hospitals can work the accounts likely to be paid in-house while outsourcing the others to a third party.

Overall, AI is really a movement toward an exception-based work environment in which employees only take on tasks automation cannot. In such a workflow, people will only be notified to monitor automated tasks on an exception basis. Automation can help reduce or eliminate the risk for error made by a person charged with typing day in and day out or copying information verbatim from an insurance card or EHR system.

In the same way, AI helps control where sensitive patient information is sent. It eliminates the need for at least one set of eyes on the data and enables information to be securely sent and accessed, meaning hospitals have greater control over who accesses patient data and where it goes.

Getting started

One question I hear often is, “Where should I start?” My advice? Start simple.

The best tasks to automate are tedious, high-volume, and repetitive. In the revenue cycle, some of these processes include checking the status of claims, working denials, or reviewing eligibility. These tasks are typically time-consuming and copy-and-paste intensive. By automating them, a hospital can address every patient account, regardless of the dollar amount attached to it.

After tackling the easy stuff, organizations can progressively deploy AI for more advanced capabilities.

Still, justifying spending thousands of dollars on new technology can be difficult. Organizations are inundated with high expenses. Consider the EHR — a single hospital stands to spend millions of dollars on a new system. But this is the wrong way to think about automation. Hospital leaders shouldn’t think about AI and automation as another price tag, but as a path to savings. What automation comes back to is being able to accomplish more with less.

Since automation enables staff to accomplish more work with fewer resources, hospitals can put additional quality controls and checks in place to help speed the time required for processing claims, reduce days in accounts receivable and reduce denials.

That’s because automation via an AI system helps staff in a couple of important ways. First off, it completes nearly 100 percent of eligibility checks on the front-end of the revenue cycle. Additionally, it helps highlight changes in payers’ reimbursement policies, which helps employees act sooner to reduce AR days or notice variations in accounts much earlier.

Here’s an example: Before automation, one hospital I worked with was spending nearly 100 hours per day checking claims statuses. With automation, the hospital was able to get through that same amount of volume in 90 minutes per day, freeing up staff to further the revenue cycle claims management process rather than waiting for payers to respond before proceeding. Automation helps get more answers with less manpower, an AI helps them turn those answers into new solutions.

Planning for the future

Nearly every hospital CFO needs options to do more with less. AI helps hospitals operate smarter, not harder. Through automation, hospitals level up to achieve exceptions-based environments in which employees are empowered to focus solely on work that requires the human touch. Whether a hospital is operating efficiently now or struggling and in need of improvement, every organization is at its best when people are serving the best purpose.

About the author: Braden Lambros

As an artificial intelligence transformation leader at Olive, an AI as a service (AIaaS) company, I observe the promise and potential of automation in cost control firsthand. I have devoted my entire career to healthcare, working as a consultant focused on revenue cycle and other labor or non-labor areas. I have worked with more than 25 healthcare organizations, from small hospitals to some of the largest health systems and academic centers in the U.S.

About Olive:

At Olive, we strive to build revolutionary artificial intelligence and robotic process automation solutions for the healthcare industry to help improve business productivity. Our efficient, cost reducing options deliver positive results with Olive overseeing repetitious high traffic processes and workflows. These specialized tools empower our customers by delivering the freedom to do the hardwork of building the future of healthcare. To learn more, visit our website.

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46 RCM tips from 2018

Dan Berger, national director of healthcare at AxiaMed, a healthcare financial technology company, advisedhospitals to take steps to ensure …
Written by Kelly Gooch | January 07, 2019 | Print |Email

Here are 46 expert revenue cycle management tips, published by Becker’s Hospital Review in 2018.

1. Tom Romeo, general manager of healthcare IT and Quanum Solutions at Quest Diagnostics, recommended hiring the right staff and utilizing their strengths appropriately.

2. Erica Franko, senior vice president and managing director of advisory and implementation services at RCM company nThrive, recommended that hospitals address patient liability by focusing on the patient experience and staff.

3. Rebecca Farrington, chief revenue officer at Healthcare Administrative Partners, recommended properly educating patients about separate billing at the time of service.

4. Peter Angerhofer, principal at Colburn Hill Group, recommended using advanced technology to target smaller subsets of claims.

5. Deborah VanCleave, vice president of revenue cycle at St. Joseph, Mo.-based Mosaic Life Care, recommended hospitals focus on the patient’s perspective.

6. Ms. VanCleavealso recommended that hospitals view the revenue cycle as a brand ambassador.

7. Dan Berger, national director of healthcare at AxiaMed, a healthcare financial technology company, advised hospitals to take steps to ensure compliance with HIPAA and payment card industry requirements with regard to patient payment collections.

8. Gerilynn Sevenikar, vice president of revenue cycle at San Diego-based Sharp Healthcare, said hospitals need to make sure they give their patients personal, customized service.

9. Parag Shah, president of practice solutions at Integra Connect, a provider of technologies and services for value-based specialty care, advised specialty medical practices to focus on performance optimization and risk management to ensure their revenue cycles meet new value-based care requirements.

10. Elaine Dunn, vice president of system integration for Craneware, a value cycle company, said it is critical that hospitals and health systems examine how the organization’s clinical systems integrate with the chargemaster.

11. Jenna Tropea, online marketing strategist at ImagineSoftware, a provider of billing automation software and revenue management applications, recommended hospitals track claim denial resolve rate to improve revenue cycle performance.

12. Rebecca Marsh, vice president of advisory services at nThrive, a revenue cycle management company, advised hospitals to conduct a comprehensive review of their chargemaster to prepare for the CMS price transparency rule taking effect Jan. 1.

13. Mark Mele, vice president of sales at Casetabs, a cloud-based surgery coordination technology provider, said hospitals should remember the importance of reducing operating room delays and last-minute cancellations as they seek to improve financially.

14. Kevin Smith, vice president of product management at nThrive, recommended hospitals use online estimator tools to help patients understand their potential out-of-pocket costs.

15. Gary Long, executive vice president and chief commercial officer of R1 RCM, a provider of technology-enabled healthcare revenue cycle management services, advisedhospitals to include both clinical interactions and nonclinical interactions when considering net promoter scores.

16. Allen Latham, vice president of revenue cycle management at TriZetto Provider Solutions, a Cognizant Company, said hospitals should focus their revenue cycles on healthcare consumers as well as healthcare “prosumers,” who gather their own health data via a wearable or sensor.

17. Dr. Dar Griffeth, senior vice president of revenue cycle management services at Pulse Systems, said lowering the number of days a bill is in accounts receivable is one way to reduce the cost to collect on the bill.

18. Bo Shi, assistant professor of finance at Morehead (Ky.) State University, said data analytics — using technology to examine and make conclusions from data sets — can help hospitals and health systems improve revenue cycle performance.

19. Scott Friesen, CEO of Newport Credentialing Solutions, an outsourced provider for privileging and credentialing solutions, said credentialing software — which helps manage the process of establishing a provider’s qualifications, board certifications, work history and references — should be integrated with provider-payer contract data.

20. Lyman Sornberger, president and CEO of consulting firm Lyman Health Care Solutions, said that hospitals should “capture insurance coverage at the benefit level” and “invest in pre-service validation with the patient and insurance for high-end service.”

21. Jay Garmon, product manager of patient responsibility at Waystar, said hospitals should establish programs to help patients pay their medical expenses. He gave the example of consistently offering cost estimates to patients before procedures, so they can financially plan for their out-of-pocket costs and seek financial assistance if needed.

22. Jonathan Wiik, author of Healthcare Revolution: The Patient is the New Payerand principal for healthcare strategy at TransUnion Healthcare, said hospitals should use technology to evaluate propensity to pay.

23. Paul Shorrosh, founder and CEO of AccuReg Software, said standardizing and automating front-end processes, such as registration, helps eliminate revenue cycle errors.

24. Paul Brient, CEO of PatientKeeper, said it’s important that healthcare executives cultivate an atmosphere that fosters collaboration with physicians toward hospital goals.

25. David Shelton, CEO of PatientMatters, said hospitals should consider a patient’s traits when establishing a payment plan. Establishing payment plans that include current credit information, payment history for financial obligations, residual income and other unique patient statistics should all be considered in the billing process, he said.

26. Erica Franko, senior vice president and managing director of advisory and implementation services at nThrive, recommended hospitals address patient liability by focusing on the patient experience and staff. “Many patients remember the days of the co-pay and are now confronted with more complex forms of liabilities. Ensuring that your staff is prepared to explain these liabilities is paramount to patient and staff satisfaction,” Ms. Franko told Becker’s. “Be sure to also prioritize point-of-service collections. Patients are more likely to pay upfront, especially if they understand how much and why they owe, and they are provided support options, if needed.”

27. Jim Dougherty, CEO of Madaket Health, recommended cutting out manual, error-prone processes in payer-provider transactions. He said healthcare organizations should automate enrollments necessary for payments.

28. Lyman Sornberger, vice president of client development at Charles J. Hilton and Associates law firm, provided three operational processes in revenue cycle management to respond to insurance claim denials. These processes include informal and formal appeals. He said providers also may bring in a third-party healthcare attorney to respond to denials.

29. Kevin Smith, vice president of product management at nThrive, said hospitals should use technology to examine changes before bills are sent to patients and identify areas of potential charge discrepancies.

30. Heather Bassett, MD, CMO of Xsolis, recommended using objective analytics to work with payers during case management.

31. Tyler Kurasek, a principal at Colburn Hill Group, an end-to-end revenue cycle solutions firm, recommended looking to analytics when using robotic process automation to improve RCM. “Using analytics to find patterns of claims that may not have the same characteristics, but require the same next step, is one way to build a volume of tasks that justifies using a robot,” he said. “Once the patterns are identified, and the robot is built, managers need to monitor its use and activity to ensure not only that all claims which qualify are being processed, but also that any new populations which should qualify are included.”

32. Tom Romeo, general manager of healthcare IT and Quanum Solutions at Quest Diagnostics, said hospitals and health systems must identify the cause of insurance claim denials to ensure proper and timely payment.

33. Tara Dwyer, vice president of audit operations at Xsolis, recommendedhospitals prioritize claim denial appeals based on the clinical merit of individual cases.

34. Monte Sandler, executive vice president of revenue cycle management at DocuTAP, recommended healthcare providers follow appropriate billing guidelines for each contract with third-party payers.

35. Rebecca Haymaker, director of Epic services at Parallon Technology Solutions, recommendedhospitals educate patients and staff to achieve a successful point-of-service collections program.

36. Jason Considine, senior vice president of patient access, collections and engagement for Experian Health, recommended hospitals closely examine online reviews from patients to gain insights to improve customer satisfaction and boost payments.

37. Amber Luliano, product manager of denial management at Waystar, recommended that hospitals invest in an effective denials program to prevent denials and ensure they recoup maximum revenue for services.

38. Eric Nilsson, chief technology officer of the SSI Group, a revenue cycle solutions company, recommended that hospitals improve cybersecurity by implementing an established security framework that meets organizational needs without being overbearing.

39. Deepti Sharma, director of product management at HSBlox, said blockchain and advanced artificial intelligence algorithms provide the answer for healthcare organizations seeking to reduce claims denials and ensure maximum provider reimbursement.

40. Rebecca Farrington, chief revenue officer at Healthcare Administrative Partners, recommended that hospitals gain insight by collaborating with hospital-based physicians.

41. Andrew Trechsel, senior associate at executive search firm Witt/Kieffer’s healthcare practice, said career stability and ambition should be a key focus for revenue cycle consultants.

42. Ryan O’Hara, chief revenue officer of Flagstaff-based Northern Arizona Healthcare, recommended focusing more on yield with respect to clinical documentation integrity.

43. Kenneth Miller, senior revenue cycle management specialist at Cantata Health, recommended using a hospital’s RCM team to gain various insights that can result in improved performance.

44. Eric Ritchie, COO of Grantsville, W.Va.-based Minnie Hamilton Health System, recommended using one platform to keep track of revenue cycle management processes.

45. Kevin Lathrop, president of TriZetto Provider Solutions, a Cognizant company, said hospitals and health systems should focus on price transparency as they pursue the retail-like financial experience patients seek in today’s healthcare environment.

46. Leonard Wenyon, vice president of revenue cycle management solutions at IKS Health, said focusing on insurance verification can help providers improve patient payments.

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