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Finance Executives Address Big Three Revenue Challenges
From left: Jim Bohnsack, chief strategy officer at Aspirion, moderates a panel discussion that includes Edna Buffington, vice president of Community Health Services Revenue Cycle; Spencer Allee, director of AI at Aspirion; Bradley Tinnermon, senior vice president of Finance Shared Services at Kaiser Permanente; and Ted Syverson, Vice President of Revenue Cycle at King’s Daughters Medical Center.
LAS VEGAS – A panel of revenue cycle experts explained their biggest challenges during the HFMA Annual Conference in Las Vegas on Tuesday.
The big three are personnel, denials, and prior authorization. Probably no one surprised the standing-room-only crowd at the Mandalay Bay Conference Center. More than 3,500 people attend the Healthcare Financial Management Association’s annual conference.
Hospital financial executives have been facing these problems for some time, with claim denials and prior authorizations becoming such a growing threat to providers’ finances that some have stopped using Medicare Advantage. reimbursementwhere denials have been widespread.
A bipartisan group of more than 50 representatives and senators sent a Letter of June 25 asking Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure for greater oversight of Medicare Advantage coverage decisions. The plans use AI to erroneously deny care, lawmakers said.
Speakers said they use AI and automation in all problem areas whenever possible.
“A Practical Approach to Using AI, ML, and Automation in the Revenue Cycle,” moderated by Jim Bohnsack, Chief Strategy Officer at Aspirion, included panelists Edna Buffington, Vice President of Revenue Cycle at Community Health Services; Spencer Allee, director of AI at Aspirion; Bradley Tinnermon, senior vice president of Finance Shared Services at Kaiser Permanente; and Ted Syverson, Vice President of Revenue Cycle at King’s Daughters Medical Center.
Hospitals have difficulty remaining competitive in attracting workers for jobs that pay the lowest wages in the health care system, such as registration. Buffington’s CHS said workers can earn $25 at a car wash, compared to $14 an hour as a hospital employee working the register.
Due to turnover, customer service is another area where hospitals struggle when registration may be the first point of contact.
CHS is using AI to automate areas like the phone system and to shift employees to other functions.
Denials are a priority for CHS, Buffington said. The healthcare system becomes very proactive in getting pre-authorization. For example, colonoscopies are being denied if there is no pre-authorization before a biopsy.
“These are the main challenges for all of us to improve our reimbursement,” Buffington said.
The CHS system automatically corrects variations in the amount paid if the insurance amount is different from what the system produced.
CHS receives a weekly denial report. It’s looking at how to implement systems for more complex denials and whether this is something to build internally or buy.
Every department in the revenue cycle is looking to build, buy or partner, said Kaiser’s Timmermon.
Many people have tried to automate the pre-clearance space and this has proven to be more challenging than imagined, Tinnermon said.
But Kaiser is doing a lot of analytical work around denial codes and what it takes to fix them.
“That’s something we’re really looking into,” Tinnerman said, “to see what we can automate.”
Denials mean money is being spent on legal appeals. Over the past seven years, there has been more legal expense spent on complex claims and contract-related issues, said Syverson of King’s Daughters Medical Center.
Kaiser Permanente is taking a deep look at automation to eliminate variations between systems, Tinnermon said. Some ideas for AI and technology improvements die on the drawing board due to a lack of connection to existing systems.
Kaiser is an integrated system that manages a risk-adjusted health plan that is expected to grow, Tinnermon said. And it runs three revenue cycles: a value-based revenue cycle; a revenue cycle for self-funded plans; and a typical fee for service revenue cycle.
In AI and automation, the first thing Kaiser looks for is stability of the core technology; the second is the collection cost; and the next step is to have systems automated in real time or take a nightly approach.
“I would say there aren’t many places we’re not looking,” Tinnermon said.
Send an email to the writer: nathaneddy@gmail.com
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