Houston, We Have a Problem

Tim Coan

As he climbed up to the command platform that gave him a view of the room full of screens, monitors and men, Gene Kranz donned his lucky white vest.  He would need it.

Engineers in short-sleeved shirts and skinny black ties reported in with a brisk cadence that they were good to go.  Apollo 13 was ready for lift-off.

By now we all know the story, wonderfully told in Ron Howard’s 1995 movie.  Soon after they reached orbit, the astronauts stirred the oxygen tanks and something went horribly wrong.  Jim Lovell would not walk on the moon as he had dreamed.  It was doubtful he would walk on the earth again.

One of the most compelling elements of the story was watching Gene Kranz’s team of men with diverse but interconnected skills come together to solve a problem for which they had never trained or prepared.  Power had to be conserved. The air onboard had to be cleaned by rigging a square filter to fit into a round hole. A manual burn to alter the trajectory of the craft had to be carefully managed.  It took every bit of knowledge from the team in Houston to get the three men in orbit back home.

Complex tasks require specialized skills.

It would be ludicrous to suggest a comparison in complexity between putting someone on the moon and getting a claim paid for a physician’s office visit.  The former has happened 12 times, ever; the latter occurs about 1.2 billion times a year. Tom Hanks is not likely to be asked to star in a movie about the high drama of processing EDI rejects from the claims clearinghouse anytime soon.

But there is no doubt that the physician revenue cycle has grown exceedingly more complex in recent years.  Payer consolidation, the increasing role of technology, and an ever growing list of compliance requirements have made billing more challenging. As with space flight, complexity demands more scope and depth of skills.

In the first post in this series, we outlined why the ability to make capital investments in RCM technology creates an advantage for the outsourcer; the ability to hire specialized talent necessary to maximize all parts of the revenue cycle is another.

In the not too distant past, all of the people working in the revenue cycle were lumped into one of two primary jobs: coders ascribing numbers to the claims on the front end, and billers on the back end entering data and dialing for dollars to get the claims paid.

How things have changed:

  • Data entry is increasingly automated, eliminating much of the low-skill work. But now, managing the flow and reconciliation of large digital data files requires a higher level of capability.
  • Technical resources are needed to integrate and support the multiple software platforms that touch the revenue cycle. Some of these technologies belong to the practice, but many reside outside, making technical integration more challenging.
  • Retail-minded people who can handle the complicated discussion with patients about payment become critical as more of the total reimbursement moves from payers to consumers.
  • EMR specialists must find ways to tighten the connection between the workflow and documentation on the clinical side of the house with what is required for billing.
  • Contract analysts model the impact of various payment agreements, especially new value-based reimbursement schemes.
  • Business intelligence experts who can make sense of all the data sit at the hub of it this process, directing traffic toward both opportunities and problems.

These people may not be NASA engineers, but are still an impressive collection of talent.

RCM outsourcing firms that enable physician practices to survive in the changing world of healthcare reimbursement are able to hire people with a wide range of specific skills.  They can then allocate those people and their expertise across many clients.  With your payment rules changing every day, you need Gene Kranz and the whole team in order to get your cash home. To learn more about how one of the largest pain management practices in the U.S. leveraged outsourcing and grew over 122% in four years, click here.



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