Revenue-cycle firms tackle value-based payment and ICD-10

Revenue-cycle management firms are evolving along with their healthcare provider clients as payment shifts from volume to value, experts say.

Providers have become adept at navigating end-to-end revenue collection, said Courtney Thayer, a principal with Deloitte Consulting. What they now need from revenue-cycle firms is a broader range of support services, particularly in maximizing revenue under new value-based payment models, she said. That requires revenue-cycle firms to offer clinical expertise to help clients meet cost and quality targets, Thayer added.

There's also a shift in how clients are paying revenue-cycle firms. Payment is becoming more dependent on providers' patient-satisfaction grades. Billing and collection practices can drive big swings on those measures, so firms must develop a strong understanding of customer engagement, Thayer said.

Even though the healthcare ecosystem has changed, “revenue cycle is still the lifeline,” she said.

Another issue bearing down on revenue-cycle firms and the providers they serve is the federally mandated Oct. 1 deadline for conversion to the ICD-10 coding system. Revenue-cycle firms are intensely preparing.

AGS Health in New York has been training employees on the coding system so that bills are sent to insurers on time and in proper form, said Devendra Saharia, CEO at AGS. The conversion is causing providers anxiety because they worry cash flow could be affected if bills are sent out in the wrong format, he said. AGS has increased staffing for its coding business by 30%, hiring 300 coders in the past three months.

But even as providers and revenue-cycle firms enter new frontiers, they must remember to be sensitive to patients' billing concerns, Saharia said.

Patients may want to pay but can't afford to, he explained. Mishandling patients or not providing them enough information may anger them to the point that they seek care from a different provider.

If patients are unable to pay, it's important to work with them on a payment strategy and help them learn the process, Saharia said.

“People are busy with their lives, and when they get sick they don't have time to investigate everything,” he added.