Answers for a Healthier World

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Jeff Tennant has over 25 years of Information Technology experience, including 15 years in Revenue Cycle consulting and leadership experience resulting in millions of dollars of improvement for health systems and other industries. Jeff has led numerous strategic revenue cycle engagements through his past roles as Hospital CIO, strategic revenue cycle consultant, and global solution leader for Revenue cycle consulting. Jeff and team brings real world experience, along with the benefit of numerous engagements helping others with best practices, and lessons learned to each engagement. Jeff is currently a member of HIMSS Revenue Cycle Task Force and has presented at HIMSS National conference (Revenue Cycle Solutions center), Arab Health Conference, HFMA Events, WEDI, AHIMA, State and regional HIMSS meetings.

Organizations need to think of the revenue cycle in healthcare as something beyond numbers and more as everything that occurs from that first initial contact with the physician, through a patient’s hospital stay, all the clinical events that may cause charges to fall, and then the components of getting the documentation in place to be able to verify and prove you did what you said you did. This also includes making sure you’re appropriately reimbursed for the great care you provided your patient. Every step is important, and each step represents a piece that leads to an effective revenue cycle. Successful and profitable healthcare institutions often have a firm grasp on all those individual steps, including visibility into the revenue cycle as a whole.

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The value of aligning financial and clinical aspects within healthcare organizations is critical to closing the gap that exists between the revenue cycle and IT departments. The need for clinical understanding in finance operations complicates these efforts, along with the siloed technology systems that hinder the ability to align the clinical with the financial systems of many healthcare providers.

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Three impediments hinder most healthcare providers. Closing the gap that exists between revenue cycle and IT is the first major issue. This challenge, although common in all industries, tends to strike the healthcare sector particularly strong because of the advancements and investments in unified electronic healthcare records (EHRs). 

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Within the healthcare industry, it can be easy to get lost in the numbers. Sources such as Healthcare Finance even suggest that hospitals looking to gain control over finances and protect their revenue streams should perform tasks such as verifying compliance of financial connectivity software. Although a myriad of activities exist that hospitals can use to potentially secure their revenue stream, in a larger sense, protecting revenue streams relies mostly on a hospital’s ability to achieve Revenue Cycle Readiness.

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It’s common knowledge that U.S. healthcare spending is astronomical. According to the Centers for Medicare and Medicaid Services (CMS), the average U.S. healthcare organization spend in 2015 increased 5.8 percent to reach $3.2 trillion. And that number has only grown. Health spending is projected to grow 5.4 percent in 2017 related to faster growth in Medicare and private health insurance spending. Health expenditures are also projected to grow at an average rate of 5.9 percent for 2018-19, the fastest of the sub-periods examined, as projected spending growth in Medicare and Medicaid accelerates.

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A regulation-based, seismic change recently hit the healthcare industry. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a Medicare payment reform, went into effect January 1, 2017. MACARA and the associated Quality Payment Program (QPP) regulation will shift the reimbursement model from a straight fee for service model to a more comprehensive value-based framework.

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Understanding and optimizing the revenue cycle is not easy. There are so many activities and steps pertaining to all administrative and clinical functions within healthcare, that the ability to capture, manage, and collect patient service revenue can seem daunting. Gaining an effective capability to do so requires that healthcare providers achieve revenue cycle readiness by examining and mapping each step from patient admittance to the release of their final bill. Each step in between represents a piece that leads to a complete revenue cycle. Successful and profitable healthcare institutions often have a firm grasp on every individual step, including visibility into the revenue cycle as a whole.

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