R. Halsey Wise, Chairman & CEO
Today, there looms an air of uncertainty surrounding the ongoing implementation of the Affordable Care Act, shifting payment models, accelerated national and regional consolidation of large hospital and health systems. In addition, an increasing emphasis is being put on evidence-based necessary care that has profound implications over payors, providers, and patients. CIOs and other healthcare executives face the challenge to find solutions managing the complexities of acute care and large medical practices, while maximizing RCM.
Healthcare institutions are aiming at improving RCM through reduced downstream problems, improved flow of information throughout the revenue cycle, increased visibility with charge data accuracy and decreased denials. “RCM is a fundamental component to any successful hospital, and how efficiently its process is carried out will determine the overall financial health of a facility. As the healthcare delivery models change, hospitals need to reshape their RCM processes,” says R. Halsey Wise, Chairman and CEO of MedAssets [NASDAQ:MDAS]. Being a healthcare performance improvement company, MedAssets focuses on helping healthcare providers realize financial and operational gains so that they can sustainably serve the needs of their community.
MedAssets provides technology-enabled products and services to healthcare organizations, including hospitals, health systems, non-acute health care providers, payors, other service providers, and product manufacturers. The company manages its business through two business segments—Spend and Clinical Resource Management (SCM) and Revenue Cycle Management (RCM). The RCM segment provides sales cycle management solutions to health care providers, primarily hospitals and health systems.
Right Execution of RCM
Today's increasing financial pressures on healthcare service associations formulate direct repercussion on consumers as they bear a prolonged monetary obligation regarding their social insurance costs. “Organizations are being asked to do more with less; cash flow is declining; bad debt is difficult to identify and collect; it is vital that medical facilities receive payments from patients and insurance companies in a timely manner,” adds Wise. Simultaneously, the revenue cycle—from the time a patient’s case is opened until final payment is received—must be managed effectively. The components in the revenue cycle are interrelated and impediments in execution may lead to financial disturbances. “Since our founding, we’ve challenged the status quo to improve the quality and effectiveness of healthcare with the help of proven industry expertise and data-based insights,” states Wise. The company’s solutions, industry experts, and data-driven methodologies are helping healthcare enterprises make informed changes to drive total cost reduction, financial optimization, clinical delivery alignment, and efficiency. They provide everything from establishing best practice value for clinical and labor resources, supply pricing, and procurement processes to reimbursement accuracy and payor contract management along with modeling.
Optimized Revenue and Efficiency through Process Improvement
The company’s evidence-based solutions, best practice processes, and analytics help the clients reduce the total cost of care, enhance operational efficiency, align clinical delivery, and improve revenue performance across the care continuum. “Whether your challenge is functional or comprehensive, successful RCM initiatives need to be cost-effective and are best when delivered through a single-point of accountability for integrated consulting, technology and services,” says Amy Amick, President, RCM segment, MedAssets. The company’s revenue cycle performance solutions have been proven to drive improvement in operational efficiency, reducing the total cost to collect by 10 percent, and increasing net revenue improvement by up to 5 percent. Their revenue cycle experts begin with assessing a provider’s operational environment to identify areas for improvement and implement recommendations based on unique business and resource needs. Wise and his team help clients sustain best practice financial performance with service-enabled revenue cycle technology and consulting. They also offer effective processes, tools, and services to prepare for and through a successful ICD-10 (International Classification of Diseases) transition. The company’s ICD-10 Readiness Services help firms ensure sustainable ICD-10 compliance with a comprehensive phased approach—assessment, remediation, testing, and pre and post go-live support, combined with on-going training and education, configured for all levels of staffing.
Revenue Performance Improvement Consulting
We offer technology solutions plus technology enabled outsourcing services delivered by highly skilled experts to increase cash flow and reduce A/R days
According to Wise, healthcare firms must identify opportunities for improved revenue cycle performance by designing and implementing financial and operational improvement plans based on quantified return on investment opportunities. This approach provides comprehensive analysis of overall revenue cycle activities to help identify, track and quantify key performance indicators by incorporating redesigned workflow and processes, optimized staffing, and enhanced utilization of technology. MedAssets’s Revenue Cycle Analytics presents a comprehensive and relevant summary of key metrics designed to improve financial, clinical, and operational performance. Its capabilities enhance insight across the enterprise—from executives to front-line associates—to more effectively identify trends, determine actionable insights, and analyze data in a meaningful way to manage their respective areas of the business. “We also offer technology solutions plus technology-enabled outsourcing services delivered by highly skilled experts to increase cash flow and reduce A/R (accounts receivable) days,” asserts Amy.
Aligning Reimbursement Strategies
With increasingly changing reimbursement models and high deductible health plans placing more payment liability with a patient, Wise thinks health systems must increase their focus on cash collections, reducing front-end denials and improving efficiencies during patient registration.
“Best practice registration and patient satisfaction will continue to grow as a strategic business issue,” says Wise. MedAssets’s Patient Access Solutions deliver performance expertise, automated workflows for greater accuracy and efficiency for financial clearance process. Department staff gains easy access to crucial information regarding patient eligibility and benefits, which means patients receive accurate and easy-to-understand estimates for both the hospital and the physician before services are provided. Additionally, the company’s Claims and Billing Solutions add the extra advantage needed to enable providers increase net revenue and compliance by automating the identification of missing charges, overcharges and coding errors with a comprehensive set of proprietary-data rules for both charge- and claim-level edits.
The company also provides solution to support enhanced clinical documentation, reduce revenue risk related to ICD-10 and improve chargemaster management. “Our Chargemaster Management manages and maintains an accurate, comprehensive and compliant chargemaster. This solution also links chargemaster files to a proprietary catalog that provides best practice charging information, benchmarks, regulatory documentation, and coding research,” adds Wise.
More than 4,500 hospitals and 123,000 non-acute healthcare providers are currently using MedAssets solutions and services. When Hackensack University Medical Center and LHP Hospital Group took over as proprietors of Montclair-based Mountainside Hospital in 2012, executive leadership continued on their decision to outsource its revenue cycle operations to MedAssets. Realizing the positive financial results MedAssets already delivered to Mountainside while part of Merit Health System, management of the now HackensackUMC Mountainside knew it could continue to leverage MedAssets expertise to achieve best-practice revenue performance and further strengthen the hospital’s revenue cycle operations. Since partnering with MedAssets in 2012, HackensackUMC Mountainside has been able to move its cash-as-a-percent-of-goal rate from 92 percent to 102 percent in the second quarter of 2014.
The Future: Offering Best Care Possible
The company aims to follow their holistic approach towards helping healthcare organizations improve revenue, performance and care delivery, combining cost and clinical resource management, purchasing, and revenue cycle solutions for the days to come. According to Wise revenue cycle is unpredictable and a reasonable eye to the ‘main driver’ of difficulties that an organization may face. “It is important that firms understand the root cause needs to be addressed in the best way available. We are here to assist with the best solutions in the industry,” concludes Wise.