Research

Developed with the intention of providing our membership community with insight into our research agenda for the months ahead, this 2016 research overview is intended to assist healthcare revenue cycle leaders in navigating and responding to the numerous shifts currently occurring within the industry, including but not limited to rises in patient out-of-pocket costs, continually strengthening payer and regulatory requirements, and a transition in reimbursement methodology, revenue cycle management, and others.

In structuring our research framework for this year, we wanted to not only consider these increasing pressures, but ensure items identified by the membership community itself as top concerns or priorities were accounted for as well. As briefly summarized below, these topics include how organizations are reconsidering the traditional healthcare revenue cycle management structure, how patients interact with the revenue cycle’s touch points, and how leaders as well as their staff can work together to prevent recurring losses in reimbursement.

Governing an Enterprise-Wide Revenue Cycle
As the industry as a whole moves from a volume- to value-based structure—which inherently brings with it increased financial risk—the previously pronounced line between the clinical and financial aspects of operations is continuing to blur. Not only are hospitals and health systems looking to integrate physician practices into the core leadership structure and align further revenue-enhancing processes under the revenue cycle wheelhouse, but organizations are also working to nurture greater collaboration and understanding between typical revenue cycle departments, enhance recruitment and development of both frontline staff and leadership, and re-evaluate potential outsourcing opportunities in order to respond to growing patient volumes and compete with forward-thinking organizations despite declining third-party reimbursement.

Analyzing and Preventing Denials While Improving Payer Relations
Informed by the needs of our membership community, The Academy is sustaining a pulse on the continued efforts of healthcare organizations to identify denial root causes and prevent their future occurrence. Not only does this require advancements in the realm of data analytics, but with so many touch points in the lifecycle of a claim, divided between a wide variety of staff groups, mitigating and preventing denials often necessitates a significant and collaborative cultural shift. In addition to internal efforts, such as developing staff workgroups around specific denial reasons, organizations are also looking to foster better relationships with their contracted payers in order to also influence unwarranted or payer-induced denials.

Evolving Patient Financial Literacy in an Increasingly Consumer-Driven Industry
Although providers continue to advance price transparency efforts given federal, and in some cases, state-based legislation, it appears many healthcare leaders are attempting to transition from increasing transparency alone to improving actual patient comprehension of their out-of-pocket costs, potential financial assistance options, and more. This is being attempted through mobile financial counseling, combined technical and professional price estimates, innovative metrics, and dedicated positions intended to measure and impact the patient financial experience, and even patient-managed payment plans.

As the year progresses, and as the impact of industry changes like 501(r) and ICD-10 unfolds, please stay in touch with The Academy for objective research regarding organizations’ responses, innovations, and strategic plans amid such a transformative era in the healthcare revenue cycle.