Below is our recent interview with David Wyatt, vice president of revenue and clearinghouse services at Greenway Health, a leading health information technology and services provider:
Q: We understand Greenway was recently ranked no. 1 for Ambulatory RCM Services by KLAS, an industry research group, for the second year in a row. Can you explain what this means for Greenway and what went into that research?
A: The ambulatory or outpatient care market is an especially crowded one for healthcare vendors, so to be recognized for the second year as a KLAS Category Leader is a true honor. We’re extremely proud of our Greenway Revenue Services team and their continued commitment to finding value for our customers in the field of revenue cycle management.
KLAS’ annual ranking is based on thousands of interviews, plus feedback from healthcare providers and payers, for a broad view of the market. Any RCM score increase is a significant achievement, representing thousands of dollars in additional customer revenue. With that in mind, GRS’ improvement to an average score of 87.8 was achieved by focusing on consulting and education to deepen customers’ RCM knowledge, facilitating on-site go lives to ensure a quick start and future success, and leveraging insights from Greenway Clearinghouse Services to improve claim acceptance rates for our customers.
Q: What are you hearing from your customers in regard to the biggest challenges they are currently facing from a business/financial perspective?
A: An overarching theme we hear from ambulatory providers is increased contention between them and payers. Needless denial of claims and declining allowables by institutional payers are top challenges facing GRS customers, meaning they might not get paid for services already rendered and may not get approved for services that patients need in the future. On top of that, the rise of high-deductible insurance plans has shifted more out-of-pocket costs to consumers, who often do not have cash on hand to pay for unexpected medical expenses. This means payments may be deferred or delayed, making them less reliable than traditional payers, while increasing stress on billing staff on the backend.
When combined with increased workloads from managing both value-based and fee-for-service payments, we’re seeing higher staff turnover as a result. Providers need serious help to address these challenges. Thankfully, Greenway has both the experience and solutions to help them manage this stress by ensuring they are using the proper billing codes, verifying eligibility and collecting co-pays before or at the time of service, among other tactics to improve profitability and manage cash flow.
Q: What real-world tips would you offer practices to overcome these challenges and better hit their revenue goals?
A: ● First and foremost, ensure your staff is staying on top of industry trends such as healthcare consumerism, government mandates, changing payment models and recent technology advancements. This could also be done by engaging front office and billing teams in the evaluation, implementation and training stages to ensure improved workflows and lighter workloads.
● Second, to ensure practice profitability, it’s important to identify a reliable RCM partner that is truly invested in the financial success of your practice. From the front office to the clinical team, you want an RCM vendor that integrates completely — helping collect payment during check-in, assisting with documentation and coding, and that operates as an extension of your team with ongoing communication and shared technology access.
● Finally, once a solution is finally selected, the next step is to develop a clear, well-documented plan for managing patient collections. Everyone on staff should be aware of the process and fully bought into their shared responsibilities, making the practice’s financial success never reliant on just one or two people in your billing department. After a few weeks or months, it’s time to evaluate progress. In the case of customers using Greenway Revenue Services, by implementing these changes, most practices see an average revenue improvement of 6%.
Q: How are new value-based care payment models affecting revenue streams?
A: Many small practices are concerned about the industry’s shift from fee-for-service to value-based care and its effect on their bottom lines. The goal of value-based care is certainly laudable: reduce healthcare costs while improving patients’ overall health through a focus on preventative and primary care. But given the size and complexity of the U.S. healthcare system, the friction that comes with this change can be seen across the industry. These new value-based care payment models are adding additional burdens to office administrative staff and billing teams — especially when first implemented. To be successful, practices need to understand the performance benchmarks set by the government for quality measures in MIPS every year. Next, they need to focus on documentation workflows to meet government-mandated requirements. And finally, they need to be prepared to monitor performance, using data and analytics to help move the needle and maximize potential revenue.
Q: If there was one thing you wish the ambulatory care market did better from a billing and collection perspective, what would it be?
A: Generally speaking, institutional payers are always going to try and make it as hard as possible for healthcare providers to get paid on claims. With this principle in mind, practices need to fully document each step of the process and get proactive to reduce claim denials. Don’t wait on innovations or updates from the payer side. Instead, practices are better off analyzing weak points in their billing and collection process using data to identify their biggest challenges. Then they can better allocate personnel to manage key areas like denial management, contract negotiations, underpayment reviews and others where they can have the biggest impact.
Q: What questions should healthcare providers ask potential RCM vendors?
A: Now more than ever, effective RCM is essential to the financial well-being of healthcare practices as businesses. As multiple regulatory initiatives converge with existing demand for faster billing cycles and cost containment, provider organizations face a perfect storm of clinical and financial challenges. As a result, practices must embrace new RCM models and best practices to improve patient collections. When selecting an RCM vendor, there are seven key questions we recommend providers ask:
● Does this company have the experience and certifications needed to offer advice on industry best practices, workflow, regulations and payer requirements?
● Does it have a call center that is available when we will need one? And will the vendor be knowledgeable about local laws and regulations?
● What type and frequency of reports can my practice expect from this vendor?
● Is this company known for its transparency and what responsibilities will it share?
● Who is responsible for payments and where will they go?
● Does this vendor have a fully integrated clearinghouse that works with my practice management and electronic health records (EHR) systems?
● Will the partner work with me to further optimize my RCM over time?
All of these items are important and play a key role in helping providers determine the best partner to meet their needs – not just now, but also into the future – and achieve their financial goals.
Q: What are Greenway’s major plans or initiatives for 2019?
A: Right now we are focused on building our next-generation, state-of-the-art EHR and practice management platform. Currently under development as Project Polaris, this new technology is designed to improve the patient experience and the health of populations, drive practice efficiencies to help providers avoid burnout, reduce costs and support new government payment models.