A recent survey of 146 CEOs by the Advisory Board (1), the CEOs voted that “sustainable cost control” was the number one priority. This is an imperative that every hospital in America must be doing in the current health care environment. Net revenue is tightening up. Smaller and smaller increases from government programs are the trend and health plans are taking the position that any new net revenue be tied to improving quality or costs. The routine annual increases are not routine anymore.

What CEOs should be focusing on is collecting all net revenue. What is the best that can be expected in net revenue collections from the revenue cycle area? Is it 90% of expected? 93%? 96%? What is preventing your organization from collecting closer to 100% of expected revenue?

We know that nothing ever happens at 100% in any field, endeavor or undertaking. Asking the question of “why not 100%” is the start of reviewing what is preventing your organization from improving on net collections. If your organization is at 91% net collections (including vendor fees, etc. from handing off old accounts), that’s pretty good. But can your organization get to 95%? Or 97%? Or 98%? What steps can be taken internally to earn an extra 3-7% of net revenue? That extra money could be the difference in meeting budget or bond market targets.

How to find your 3-7% extra net revenue:

1. Adoption of a new attitude. Policies and procedures have been adopted over time that balance the effort and expense of collecting versus the return. Making policies that allow for write offs of cases under $500 or $300 creates the mindset that it is ok to “just write it off.” If $500 is ok to write off, then why not the $15 co-pay? The concept is to reinforce the attitude that NOTHING is written off without a “good” reason. Hospital revenue cycle leaders get under pressure to lower A/R and it is too easy to compromise on small amounts that can add up. But when its ok to write off $15 it becomes easier to write off larger amounts. Additionally, reinforcing the attitude of no write off without a good reason helps support collection efforts of the front offices as well as in the back end
2. Trend analysis needs to be refined and acted upon more quickly. The new analysis is one plus one equals a trend. Reporting in revenue cycle often trends towards financial statistics and contractuals. Reporting needs to get more granular and specific to highlight trends in more real time. The best way to get real time information is to educate and empower your skilled staff.
3. The staff need to understand that when they see something happen twice – sound the alarm. Getting a denial or a rejection you don’t understand once happens. But twice is a trend. You do not need to wait until 10 or 50 or 100 examples occur to request an investigation, create a report and send to a payer. Health plan payment systems are very precise and anything unusual needs to be acted upon immediately.
4. Get better at reporting and documentation – fast. To support the staff, create rigor in the documentation of issues with plans. Nothing helps contract discussions for the managed care lead than starting off with how difficult the health plan is administratively. Reporting also needs to be detailed and refined in new ways to spot trends and support the managed care staff.
5. Establish new interactions with payers – set expectations and standards. Monthly meetings with payers need to reframed. The managed care lead needs to get agreement on performance and service expectations of the health plan. Simple expectations of responsiveness, service turnaround, etc. is imperative and needs to be enforced with the health plans.
6. Use process improvement techniques – be rigorous. Collecting the last few percentage points of revenue requires focus and discipline. Using process improvement techniques and their rigor is a must to gain and sustain results.

Hospitals need to ask the question: what more can be done to gain net revenue? Re-evaluating the revenue cycle and creating a “need attitude” is key. Adding a new focus and training for staff will create the ability to approach payers in a new way for new results.

(1) 2018 Advisory Board Research Annual Health Care CEO Survey conducted between December 2017 and March 2018.

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