Healthcare Financial Management to Quote Jonathan Clark

Healthcare Financial Management

To quote Jonathan Clark at the beginning of his article, "Improving the revenue cycle can be a daunting task due to the scope and complexity of the interdepartmental process." Of the suggestions offered by the authors, which concept(s) give you the greatest insight into creating an improved Revenue Cycle process in the organization where you work (or one in which you are familiar)? Be sure to identify which article or author you are referencing.

In his comprehensive advisory article to improve the medical industry's revenue capturing capabilities, entitled Strengthening the Revenue Cycle: A 4-Step Method for Optimizing Payment, Jonathan Clark provides a series of sensible solutions to the ongoing dilemma of payment optimization. David Hammer also provides guidance to healthcare finance professional in his article The Next Generation of Revenue Cycle Management, by reminding them that the key performance indicators (KPIs) which dictated policy in previous years have been fundamentally altered by the shifting healthcare landscape. One component of Clark's four-pronged approach to optimizing revenue within large hospitals that appealed directly to my own experience working within the medical industry was his directive to Enhance Workflow Processes. After witnessing firsthand the ineffective and wasteful deployment of resources that many large healthcare providers engage in, I agree his contention that "implementing efficient processes throughout each department also is critical to achieving optimal payment" (Clark 2008). The benefit of streamlining a healthcare financial manager's Revenue Cycle is confirmed by Hammer, who concludes that "an increased emphasis on upstream and midstream functions of scheduling, patient access (especially preregistration), insurance verification and authorization, financial counseling, point-of-service collections, and health information management" is key to maximizing revenue streams (2007).

2.) In negotiating a health plan contract, why is it important to spell out precisely what constitutes a clean claim?

In cases when the definitional requirements of a clean claim have not been clearly and conclusively established, payers are far more likely to delay payment, or provide only partial payment, rather than providing full compensation for what would ordinarily be considered to be a perfectly legitimate health care claim. Contractual agreements on the precise limits of a clean claim prevent payers from unscrupulously exploiting ambiguous legal language to avoid fulfilling honest health insurance claims or other genuine requests for financial support.

3.) Consumer-driven health plans often rely on large deductibles often funded via a health savings account framework. How might the presence of a large deductible affect price elasticity for health services?

While traditional health insurance coverage typically distributes payments to hospitals, medical centers and pharmacies to compensate them for providing insured patients with certain health services, the increased deductibles inherent to consumer-driven plans force much of the initial cost onto the patient. The increased financial burden inflicted patients by these large deductibles inevitably motivates many people to avoid seeking healthcare services unless in case of emergency, or to shift their personal policy to the provider with the lowest cost. The increased price of healthcare services under the higher deductibles of consumer-driven plans drastically reduces demand, illustrating that medical services are largely price elastic.

6). Drawing from any of the articles and other material presented in this document consider the following question: Which of these concepts concerning negotiations do you think could be applied by you personally at your organization, home, or other setting, that would have a desirable effect.

Due to the extremely complex nature of healthcare management, which involves constantly shifting pricing structures, regulatory and legislative oversight, and interaction with pharmaceutical conglomerates and medical device manufacturers, knowing how to pursue productive negotiations with third party-payers is an essential skill. The lessons found in Negotiating Skills: An Imperative When Contracting are directly applicable to the demands of modernized healthcare management, covering the most successful methods through which to learn the art of effective negotiating tactics. Personally, I found the sensible advice given by David Wilson in his article 3 Steps to Profitable Managed Care Contracts, which identifies "key business items as claims submission and payment provisions; protection against catastrophic cases; procedure-based carve out payments; stop loss payment structures; and payment for exceptionally costly items such as implants" (2004) to be especially relevant given the current uncertainties pervading the healthcare finance industry. The concept of developing and using a quality set of business practices when contracting has never been more imperative than it is today, with a major restructuring of the health insurance market on the horizon. I also agree wholeheartedly with the recommendation to use intensive preparation as the foundation to future success in the field of negotiation, because the amount of circumstance-specific knowledge one possesses prior to a bargaining session is directly correlated to their chances of securing the most optimal parameters for a deal.

7.) Considering the processes used in the management of the revenue cycle by your organization, or an organization of which you are familiar, how well do you feel the organization is taking a system view when managing the revenue cycle?