By James P. Fee, MD, CCS, CCDS
The Healthcare Financial Management Association (HFMA) recently hosted its Annual National Institute (ANI) at Orlando, Florida’s Orange County Convention Center. Thousands of health care professionals flooded meeting rooms and exhibit halls to discuss the transition from fee-for-service to value-based care.
However, with reimbursements down and denials on the rise, attendees also remained firmly entrenched in the current diagnosis-related group (DRG)-based reimbursement system. Dozens of sessions focused on the need to continually assess, improve, and monitor revenue cycle operations including clinical documentation integrity, medical record coding, financial compliance, and denial management.
During HFMA ANI, three essential themes emerged: enterprisewide collaboration, physician engagement, and ambulatory care partnerships. Getting involved in these revenue cycle initiatives will be a key success factor for HIM professionals in the years ahead.
Collaboration Theme and HIM Mission
Convention speakers endorsed greater industry collaboration to bridge the realities of today with the long-term goals of tomorrow. From interdepartmental collaboration to stronger payer-provider relationships, building networks was a central theme. HFMA hosted a popular members-only “Collaboration Hub” to share concerns and brainstorm solutions for the association’s journey from volume to value. The importance of collaboration was even carried into the social realm during an evening reception, “Cheers to Collaboration.”
Collaboration is also an important mission for HIM. HIM professionals must raise awareness and remain engaged in the transition to value-based reimbursement by building relationships with outpatient HIM counterparts and learning more about the future of health care reimbursement. The following are four important collaboration points for HIM professionals to consider in 2017:
Proactive Physician Engagement Linchpin for Success
While the health care industry is moving toward value-based reimbursement, DRGs still pay claims and case mix index matters to CFOs. The duality of health care revenue requires a careful balance. Revenue cycle executives often find themselves foregoing upfront reimbursement in a fee-for-service world to support optimal quality outcome reporting under value-based initiatives—or vice versa.
One area for improvement under both models is proactive physician engagement. Many new payment plans are being established with physician subsidiaries of health care systems such as accountable care organizations (ACOs) and clinically integrated networks (CINs).
According to the Leavitt Partners and Accountable Care Learning Collaborative, more than 32 million patients in the United States received health care from one of 923 ACOs as of March 31. This represents an annual increase of 2.2 million covered lives and 11% growth in the number of ACOs from 2016. According to a recent Health Affairs Brief, other APMs are also growing, including episode-based and full or partial capitation models.
Instead of waiting until a low STAR rating is received or the organization ranks poorly in US News & World Report, ANI attendees were encouraged to take the following preemptive measures to engage physicians:
Ambulatory Care Revenue Cycle Next Horizon
As mentioned, revenue cycle collaboration beyond the inpatient setting and into ambulatory markets was a key focus at HFMA ANI. However, monitoring cost and care across an entire episode of care, even up to 90 days postdischarge for some APMs, is a challenge for many organizations. Most HIT systems were not designed to compile charges, documentation, codes, or bills across multiple providers or encounters. Attendees in the HFMA ANI exhibit hall were clearly looking for vendors to bridge the gap.
Questions posed at the Enjoin booth centered around technology and services. Attendees were seeking comprehensive solutions to encompass a broader view of patient care and revenue cycle management. Separate systems for each care setting will become a losing proposition for health care’s revenue cycle companies in the years ahead.
HIM Professionals Get Involved and Stay Informed
The link between clinical documentation integrity, accurate medical record coding, and correct quality outcome reporting will continue to solidify under value-based reimbursement. Strong HIM relationships and collaboration can help organizations connect where health care is today to where we are headed tomorrow.
HFMA ANI 2018 will be held June 24–27 in Las Vegas. In the meantime, consider attending an HFMA regional event and ask yourself: What can HIM do to meet HFMA’s future goals?
— James P. Fee, MD, CCS, CCDS, is the vice president of Enjoin.
ZirMed Inc, a provider of cloud-based revenue cycle software and predictive analytics, recently announced a major milestone for its Claims Management solution. ZirMed’s advanced technology has earned the Healthcare Financial Management Association (HFMA) Peer Review designation, which provides health care financial managers with an objective third-party evaluation of solutions used in the health care workplace.
The announcement was made from the floor of the HFMA’s 2017 Annual National Institute, where ZirMed was exhibiting.
Filing claims and collecting payments from commercial and government payers is one of the most mission-critical aspects of health care financial operations, and it has taken on increased importance in this era of dwindling margins when lost revenue is simply unacceptable. Yet, efforts to minimize revenue leakage are still a daily struggle for many providers. ZirMed’s Claims Management solution streamlines and automates workflows to enable faster, more complete payments; lower costs; and increased efficiency under all reimbursement models. It optimizes cash flow and reduces the cost of collections.
— Source: ZirMed
Craneware, Inc, a provider of automated value cycle solutions, recently announced the general availability of Trisus Claims Informatics. The cloud-based solution enables hospitals and health systems to drive revenue growth and increase compliance by automating claims review for completeness, accuracy, and patterns of charging behavior.
Craneware’s new Trisus platform combines revenue integrity, cost management, and decision enablement into a single cloud-based platform. As the first product available on this innovative platform, Trisus Claims Informatics accesses data daily compiled from more than 200 million related Medicare and commercial payer claims to provide predictive analytics and root-cause analysis around charge capture issues.
— Source: Craneware, Inc